Special Prey, Special Glue: NMR Spectroscopy on Aggregate Glue Components of Moth-Specialist Spiders, Cyrtarachninae.

Orb-weaver spiders produce upwards of seven different types of silk, each with unique material properties. We focus on the adhesive within orb-weaving spider webs, aggregate glue silk. These droplets are composed of three main components: water, glycoproteins, and a wide range of low molecular mass compounds (LMMCs). These LMMCs are known to play a crucial role in maintaining the material properties of the glycoproteins, aid in water absorption from the environment, and increase surface adhesion. Orb-weavers within the Cyrtarachninae subfamily are moth specialists and have evolved glue droplets with novel material properties. This study investigated the biochemical composition and diversity of the LMMCs present in the aggregate glue of eight moth-specialist species and compared them with five generalist orb-weavers using nuclear magnetic resonance (NMR) spectroscopy. We hypothesized that the novel drying ability of moth-specialist glue was accompanied by novel LMMCs and lower overall percentages by silk weight of LMMCs. We measured no difference in LMMC weight by the type of prey specialization, but observed novel compositions in the glue of all eight moth-catching species. Further, we quantified the presence of a previously reported but unidentified compound that appears in the glue of all moth specialists. These silks can provide insight into the functions of bioadhesives and inform our own synthetic adhesives.

Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models.

We evaluated the performance of a large language model called ChatGPT on the United States Medical Licensing Exam (USMLE), which consists of three exams: Step 1, Step 2CK, and Step 3. ChatGPT performed at or near the passing threshold for all three exams without any specialized training or reinforcement. Additionally, ChatGPT demonstrated a high level of concordance and insight in its explanations. These results suggest that large language models may have the potential to assist with medical education, and potentially, clinical decision-making.

Behavior and Bioadhesives: How Bolas Spiders, Mastophora hutchinsoni, Catch Moths.

Spiders use various combinations of silks, adhesives, and behaviors to ensnare and trap prey. A common but difficult to catch prey in most spider habitats are moths. They easily escape typical orb-webs because their bodies are covered in sacrificial scales that flake off when in contact with the web's adhesives. This defense is defeated by spiders of the sub-family of Cyrtarachninae, moth-catching specialists who combine changes in orb-web structure, predatory behavior, and chemistry of the aggregate glue placed in those webs. The most extreme changes in web structure are shown by bolas spiders, who create a solitary capture strand containing only one or two glue droplets at the end of a single thread. They prey on male moths by releasing pheromones to draw them within range of their bolas, which they flick to ensnare the moth. We used a high-speed video camera to capture the behavior of the bolas spider Mastophora hutchinsoni. We calculated the kinematics of spiders and moths in the wild to model the physical and mechanical properties of the bolas during prey capture, the behavior of the moth, and how these factors lead to successful prey capture. We created a numerical model to explain the mechanical behavior of the bolas silk during prey capture. Our kinematic analysis shows that the material properties of the aggregate glue bolas of M. hutchinsoni are distinct from that of the other previously analyzed moth-specialist, Cyrtarachne akirai. The spring-like behavior of the M. hutchinsoni bolas suggests it spins a thicker liquid.

Mechanics of the Prey Capture Technique of the South African Grassland Bolas Spider, Cladomelea akermani.

Spiders use various combinations of silks, adhesives, and behaviors to ensnare prey. One common but difficult-to-catch prey is moths. They easily escape typical orb-webs because their bodies are covered in tiny sacrificial scales that flake off when in contact with the web's adhesives. This defense is defeated by spiders of the sub-family of Cyrtarachninae-moth-catching specialists who combine changes in orb-web structure, predatory behavior, and chemistry of the aggregate glue placed in those webs. The most extreme changes in web structure are shown by the bolas spiders which create only one or two glue droplets at the end of a single thread. They prey on male moths by releasing pheromones to draw them close. Here, we confirm the hypothesis that the spinning behavior of the spider is directly used to spin its glue droplets using a high-speed video camera to observe the captured behavior of the bolas spider Cladomelea akermani as it actively spins its body and bolas. We use the kinematics of the spider and bolas to begin to quantify and model the physical and mechanical properties of the bolas during prey capture. We then examine why this species chooses to spin its body, an energetically costly behavior, during prey capture. We test the hypothesis that spinning helps to spread pheromones by creating a computational fluid dynamics model of airflow within an open field and comparing it to that of airflow within a tree, a common environment for bolas spiders that do not spin. Spinning in an open environment creates turbulent air, spreading pheromones further and creating a pocket of pheromones. Conversely, spinning within a tree does little to affect the natural airflow.

Live donor kidney transplantation. Situation analysis and roadmap.

Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spainhave adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.

Connecting materials, performance and evolution: a case study of the glue of moth-catching spiders (Cyrtarachninae).

Morphological structures and extended phenotypes are made possible by materials that are encoded by the genome. Nearly all biomaterials are viscoelastic, which means that to understand performance, one must understand the strain rate-dependent properties of these materials in relevant ecological interactions, as the behavior of a material can vary dramatically and rapidly. Spider silks are an example of materials whose properties vary substantially intra- and inter-specifically. Here, we focus on aggregate silk, which functions as a biological adhesive. As a case study to understand how a material manifests from genome through organism to ecology, we highlight moth-specialist spiders, the Cyrtarachninae, and their glues as an ideal experimental system to investigate the relationship between genomics and ecologically variable performance of a biological material. There is a clear eco-evolutionary innovation that Cyrtarachne akirai and related species have evolved, a unique trait not found in other spiders, a glue which overcomes the scales of moths. By examining traditional orb-weavers, C. akirai and other subfamily members using biomechanical testing and genomic analysis, we argue that we can track the evolution of this novel bioadhesive and comment on the selection pressures influencing prey specialization. The importance of the ecological context of materials testing is exemplified by the poor performance of C. akirai glue on glass and the exceptional spreading ability and adhesive strength on moths. The genetic basis for these performance properties is experimentally tractable because spider silk genes are minimally pleiotropic and advances in genomic technologies now make possible the discovery of complete silk gene sequences.

Live donor kidney transplantation. Situation analysis and roadmap. / Trasplante renal de donante vivo. Análisis de situación y hoja de ruta.

Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spain have adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.

TWEAK Signaling Pathway Blockade Slows Cyst Growth and Disease Progression in Autosomal Dominant Polycystic Kidney Disease.

BACKGROUND: In autosomal dominant polycystic kidney disease (ADPKD), cyst development and enlargement lead to ESKD. Macrophage recruitment and interstitial inflammation promote cyst growth. TWEAK is a TNF superfamily (TNFSF) cytokine that regulates inflammatory responses, cell proliferation, and cell death, and its receptor Fn14 (TNFRSF12a) is expressed in macrophage and nephron epithelia. METHODS: To evaluate the role of the TWEAK signaling pathway in cystic disease, we evaluated Fn14 expression in human and in an orthologous murine model of ADPKD. We also explored the cystic response to TWEAK signaling pathway activation and inhibition by peritoneal injection. RESULTS: Meta-analysis of published animal-model data of cystic disease reveals mRNA upregulation of several components of the TWEAK signaling pathway. We also observed that TWEAK and Fn14 were overexpressed in mouse ADPKD kidney cysts, and TWEAK was significantly high in urine and cystic fluid from patients with ADPKD. TWEAK administration induced cystogenesis and increased cystic growth, worsening the phenotype in a murine ADPKD model. Anti-TWEAK antibodies significantly slowed the progression of ADPKD, preserved renal function, and improved survival. Furthermore, the anti-TWEAK cystogenesis reduction is related to decreased cell proliferation-related MAPK signaling, decreased NF-κB pathway activation, a slight reduction of fibrosis and apoptosis, and an indirect decrease in macrophage recruitment. CONCLUSIONS: This study identifies the TWEAK signaling pathway as a new disease mechanism involved in cystogenesis and cystic growth and may lead to a new therapeutic approach in ADPKD.

Extracorporeal Membrane Oxygenation Retrieval in Coronavirus Disease 2019: A Case-Series of 19 Patients Supported at a High-Volume Extracorporeal Membrane Oxygenation Center.

OBJECTIVE: To evaluate the performance of the extracorporeal membrane oxygenation retrieval team at a high-volume extracorporeal membrane oxygenation center during the coronavirus disease 2019 pandemic. DESIGN: Observational study including all adult patients with confirmed infection due to severe acute respiratory syndrome coronavirus-2 cannulated at other centers and transported on extracorporeal membrane oxygenation to the ICU of the Vall d'Hebron University Hospital between 15 March and 10 June 2020. SETTING: The ICU (capacity expanded to 200 during the pandemic) of the Vall d'Hebron University Hospital (a 1,100-bed public university hospital in Barcelona), the referral center for extracorporeal respiratory support in Catalonia (7.5 million inhabitants). PATIENTS: Extracorporeal membrane oxygenation was considered if the Pao2/Fio2 ratio less than 80 mm Hg (refractory to prone position) and/or Paco2 greater than 80 mm Hg and pH less than 7.25 for more than 6 hours, and no contraindications for extracorporeal support were present. INTERVENTIONS: Venovenous extracorporeal membrane oxygenation was initiated in the primary center. Then, patients were transferred to the ICU of the Vall d'Hebron University Hospital where they received support until respiratory improvement. After decannulation, patients were discharged for rehabilitation at the primary center. MEASUREMENTS AND MAIN RESULTS: Nineteen patients with severe acute respiratory syndrome coronavirus-2 infection and with a mean Pao2/Fio2 ratio of 71 mm Hg (57-118 mm Hg) despite prone positioning and a mean Paco2 of 70 mm Hg (47-110 mm Hg) were transferred to our center from their primary hospital after cannulation and received venovenous extracorporeal membrane oxygenation support. Prior to cannulation, six patients (31.5%) presented vascular thrombosis, and nine (47.4%) were already receiving anticoagulant therapy. Eighteen transfers were carried out with no significant complications. While on extracorporeal membrane oxygenation, thrombotic events were recorded in nine patients (47.4%) and hemorrhagic events in 13 (68.4%). Thirteen patients (68.4%) were successfully weaned, and 12 (63.1%) were discharged home. CONCLUSIONS: Extracorporeal membrane oxygenation retrieval can rescue young, previously healthy patients with severe coronavirus disease 2019 in whom all the conventional respiratory measures have failed. Thrombotic and hemorrhagic complications are frequent in this cohort.

The moth specialist spider Cyrtarachne akirai uses prey scales to increase adhesion.

Contaminants decrease adhesive strength by interfering with substrate contact. Spider webs adhering to moths present an ideal model to investigate how natural adhesives overcome contamination because moths' sacrificial layer of scales rubs off on sticky silk, facilitating escape. However, Cyrtarachninae spiders have evolved gluey capture threads that adhere well to moths. Cyrtarachne capture threads contain large glue droplets oversaturated with water, readily flowing but also prone to drying out. Here, we compare the spreading and adhesion of Cyrtarachne akirai glue on intact mothwings, denuded cuticle and glass to the glue of a common orb-weaving spider, Larinioides cornutus, to understand how C. akirai glue overcomes dirty surfaces. Videos show that C. akirai's glue spreading accelerates along the underlying moth cuticle after the glue seeps beneath the moth scales-not seen on denuded cuticle or hydrophilic glass. Larinioides cornutus glue droplets failed to penetrate the moth scales, their force of adhesion thus limited by the strength of attachment of scales to the cuticle. The large size and low viscosity of C. akirai glue droplets function together to use the three-dimensional topography of the moth's scales against itself via capillary forces. Infrared spectroscopy shows C. akirai glue droplets readily lose free-flowing water. We hypothesize that this loss of water leads to increased viscosity during spreading, increasing cohesive forces during pull-off. This glue's two-phase behaviour shows how natural selection can leverage a defensive specialization of prey against themselves and highlights a new design principle for synthetic adhesives for adhering to troublesome surfaces.

Supersaturation with water explains the unusual adhesion of aggregate glue in the webs of the moth-specialist spider, Cyrtarachne akirai.

Orb webs produced by araneoid spiders depend upon aggregate glue-coated capture threads to retain their prey. Moths are challenging prey for most spiders because their scales detach and contaminate the glue droplets, significantly decreasing adhesion. Cyrtarachne are moth-specialist orb-weaving spiders whose capture threads adhere well to moths. We compare the adhesive properties and chemistry of Cyrtarachne aggregate glue to other orb-weaving spiders to test hypotheses about their structure, chemistry and performance that could explain the strength of Cyrtarachne glue. We show that the unusually large glue droplets on Cyrtarachne capture threads make them approximately 8 times more adhesive on glass substrate than capture threads from typical orb-weaving species, but Cyrtarachne adhesion is similar to that of other species after normalization by glue volume. Glue viscosity reversibly changes over 1000-fold in response to atmospheric humidity, and the adhesive strength of many species of orb spiders is maximized at a viscosity of approximately 105-106 cst where the contributions of spreading and bulk cohesion are optimized. By contrast, viscosity of Cyrtarachne aggregate glue droplets is approximately 1000 times lower at maximum adhesive humidity, likely facilitating rapid spreading across moth scales. Water uptake by glue droplets is controlled, in part, by hygroscopic low molecular weight compounds. NMR showed evidence that Cyrtarachne glue contains a variety of unknown low molecular weight compounds. These compounds may help explain how Cyrtarachne produces such exceptionally large and low viscosity glue droplets, and also why these glue droplets rapidly lose water volume after brief ageing or exposure to even slightly dry (e.g. < 80% RH) conditions, permanently reducing their adhesion. We hypothesize that the combination of large glue droplet size and low viscosity helps Cyrtarachne glue to penetrate the gaps between moth scales.

Silk structure rather than tensile mechanics explains web performance in the moth-specialized spider, Cyrtarachne.

Orb webs intercept and retain prey so spiders may subdue them. Orb webs are composed of sticky, compliant spirals of capture silk spun across strong, stiff major ampullate silk threads. Interplay between differences in the mechanical properties of these silks is crucial for prey capture. Most orb webs depend upon insects contacting several radial and capture threads for successful retention. Moths, however, escape quickly from most orb webs due to the sacrificial scales covering their bodies. Cyrtarachne orb webs are unusual as they contain a reduced number of capture threads and moths stick unusually well to single threads. We aimed to determine how the tensile properties of the capture spiral and radial threads spun by Cyrtarachne operate in retention of moth prey. A NanoBionix UTM was used to quantify the material properties of flagelliform and major ampullate threads to test if Cyrtarachne's reduced web architecture is accompanied by improvements in tensile performance of its silk. Silk threads showed tensile properties typical of less-specialized orb-weavers, with the exception of high extensibility in radial threads. Radial thread diameters were 62.5% smaller than flagelliform threads, where commonly the two are roughly similar. We utilized our tensile data to create a finite element model of Cyrtarachne's web to investigate energy dissipation during prey impact. Large cross-sectional area of the flagelliform threads played a key role in enabling single capture threads to withstand prey impact. Rather than extraordinary silk, Cyrtarachne utilizes structural changes in the size and attachment of silk threads to facilitate web function.

Spiders Tune Glue Viscosity to Maximize Adhesion.

Adhesion in humid conditions is a fundamental challenge to both natural and synthetic adhesives. Yet, glue from most spider species becomes stickier as humidity increases. We find the adhesion of spider glue, from five diverse spider species, maximizes at very different humidities that matches their foraging habitats. By using high-speed imaging and spreading power law, we find that the glue viscosity varies over 5 orders of magnitude with humidity for each species, yet the viscosity at maximal adhesion for each species is nearly identical, 10(5)-10(6) cP. Many natural systems take advantage of viscosity to improve functional response, but spider glue's humidity responsiveness is a novel adaptation that makes the glue stickiest in each species' preferred habitat. This tuning is achieved by a combination of proteins and hygroscopic organic salts that determines water uptake in the glue. We therefore anticipate that manipulation of polymer-salts interaction to control viscosity can provide a simple mechanism to design humidity responsive smart adhesives.

Built for speed: strain in the cartilaginous vertebral columns of sharks.

In most bony fishes vertebral column strain during locomotion is almost exclusively in the intervertebral joints, and when these joints move there is the potential to store and release strain energy. Since cartilaginous fishes have poorly mineralized vertebral centra, we tested whether the vertebral bodies undergo substantial strain and thus may be sites of energy storage during locomotion. We measured axial strains of the intervertebral joints and vertebrae in vivo and ex vivo to characterize the dynamic behavior of the vertebral column. We used sonomicrometry to directly measure in vivo and in situ strains of intervertebral joints and vertebrae of Squalus acanthias swimming in a flume. For ex vivo measurements, we used a materials testing system to dynamically bend segments of vertebral column at frequencies ranging from 0.25 to 1.00 Hz and a range of physiologically relevant curvatures, which were determined using a kinematic analysis. The vertebral centra of S. acanthias undergo strain during in vivo volitional movements as well as in situ passive movements. Moreover, when isolated segments of vertebral column were tested during mechanical bending, we measured the same magnitudes of strain. These data support our hypothesis that vertebral column strain in lateral bending is not limited to the intervertebral joints. In histological sections, we found that the vertebral column of S. acanthias has an intracentral canal that is open and covered with a velum layer. An open intracentral canal may indicate that the centra are acting as tunics around some sections of a hydrostat, effectively stiffening the vertebral column. These data suggest that the entire vertebral column of sharks, both joints and centra, is mechanically engaged as a dynamic spring during locomotion.

Día a día. Efemérides comentadas para los centros educacionales / From day to day. Daily record comments for teaching centers

Inmersos en la actual batalla de ideas y en aras de contribuir al logro de una cultura general e integral se realizó este trabajo. Su objetivo es contribuir al incremento de materiales didácticos para una formación político–ideológica de los estudiantes, con vistas a una mejor proyección cultural integral en el desempeño de su profesión. Consiste en un libro que brinda información sobre hechos ocurridos en diferentes ramas del saber humano y esferas de la vida del hombre, en cada uno de los días del año. Abarca fecha de nacimiento y muerte de personalidades, hechos en el ámbito histórico, científico-técnico y cultural, fundamentalmente de Cuba; también se incluyen otros acontecimientos ocurridos en el mundo que tuvieron repercusión en nuestro país. Consta de 731 efemérides comentadas, acompañadas, algunas de ellas, de información visual. El trabajo aporta información a los estudiantes y contribuye a subsanar las insuficiencias informativas (AU)

This work was carried out in the current battle of ideas and with the objective of contributing to the achievement of a general and integral culture. Its objective is to contribute to the increment of didactic materials for the political-ideological formation of the students, so as to achieve their integral cultural projection. It consists of a book that offers information on facts that happened in different branches of human knowledge and spheres of men's life. It includes the date of birth and death of personalities, historical as well as scientific, technological and cultural facts, mainly in Cuba. Other world events that had repercussion in our country are included. It consists of 731 commented events, some of them complemented with visual information. This research offers information to the students and contributes to correct information inadequacies (AU)

La educación en valores humanos: fundamento de las estrategias educativas / Education on Human Values: Basis for educative strategies

El presente trabajo responde esencialmente a la necesidad de capacitar a los recursos humanos que intervienen en el proceso de formación de los profesionales de la salud (docentes, trabajadores no docentes y directivos) para asumir con plenitud la tarea del desarrollo del trabajo formativo sobre las actuales concepciones filosóficas, pedagógicas y psicológicas, que están elaboradas tanto a escala nacional como internacional. Este diplomado contribuye al desarrollo sobre bases científicas de la estrategia educativa y los proyectos educativos que se elaboran en el Centro. Por ello el objetivo es el de hacer una propuesta de actividad de postgrado (Diplomado) que permita la preparación teórica y metodológica del personal docente y de dirección de la Educación Médica Superior para desarrollar la educación en valores a través del proyecto educativo, así como brindar herramientas prácticas para el diseño de las estrategias educativas. El diplomado que se muestra está aprobado como actividad de los programas nacionales e internacionales de postgrados del MINSAP y la ENSAP, y ha sido impartido en dos versiones en el ISCM Carlos J Finlay de Camaguey con resultados positivos. Este curso de superación es el resultado lógico del desarrollo de tesis de maestrías y de otros cursos cortos contemplados en el plan de superación del Instituto de varios profesores involucrados en el mismo (AU)

This work responds essentially to the necessity of qualifying the human resources that intervene in the health professionals' formation process to assume with great quality the carrying out of the formative work, taking into consideration the current philosophical, pedagogical and psychological conceptions elaborated at national as well as international levels. This postgraduate course contributes to the development on scientific bases of the educational strategy and the educational projects that are elaborated. For this reason, the main objective is making a proposal of postgraduate studies that foster professors ' theoretical and methodological preparation, to develop values education through the educational project, as well as to offer practical tools for the design of educational strategies. The postgraduate course that is presented is approved as an activity of the national and international programs of postgraduate studies of MINSAP and ENSAP, and it has been carried out in two versions in Carlos J Finlay Medical School in Camagüey with positive results. This course is the logical result of the development of master degree scientific papers and of other short courses contemplated in the Medical School professors' development planning (AU)

Sjögren syndrome or sjögren disease? The histological and immunological bias caused by the 2002 criteria.

The current 2002 classification criteria do not cover the broad clinical and immunological heterogeneity of primary Sjögren syndrome (SS), since five of the six criteria focus exclusively on glandular involvement and the remaining criterion is the mandatory presence of anti-Ro/La antibodies. The aim of this study was to analyze the clinical features of patients with a well-established diagnosis of primary SS who do not fulfill the 2002 classification criteria. Five hundred seven patients diagnosed with primary SS (1993 criteria) were consecutively included and followed up. Two hundred twenty-one (44%) patients did not fulfill the 2002 criteria. These patients were older at diagnosis (p < 0.001) and had a lower frequency of parotid enlargement (p = 0.002), fever (p = 0.041), arthritis (p = 0.041), vasculitis (p = 0.050), peripheral neuropathy (p = 0.002), cranial nerve involvement (p = 0.015), raised erythrocyte sedimentation rate ( ESR) levels (p < 0.001), anemia (p < 0.001), leukopenia (p = 0.037), hypergammaglobulinemia (p < 0.001), positive rheumatoid factor ( RF; p = 0.002), and cryoglobulinemia (p = 0.049) in comparison with those fulfilling 2002 criteria. However, there were no significant differences in the prevalence of sicca features, diagnostic tests, overall systemic involvement, antinuclear antibodies , complement levels, development of B-cell lymphoma, or survival. Patients with anti-Ro antibodies had the highest frequencies of systemic features, hematological abnormalities, and altered immunological markers. In conclusion, patients fulfilling the 2002 criteria, who have either a specific histological diagnosis (lymphocytic infiltration) or highly specific autoantibodies (Ro/La), might well be considered to have Sjögren "disease." In contrast, etiopathogenic mechanisms other than lymphocytic-mediated epithelial damage could be involved in patients with negative Ro and negative biopsy, in whom the term Sjögren "syndrome" seems more adequate.

Pathogenic significance of hypertrophic mesothelial cells in peritoneal effluent and ex vivo culture.

The presence of hypertrophic mesothelial cells (HMCs) in peritoneal effluent (PE) has been considered a possible marker for peritoneal sclerosis. We conducted the present study to evaluate if the presence of HMCs in PE or in culture was related to peritoneal function alterations or to the development of sclerosing peritonitis. We prospectively studied 32 new peritoneal dialysis (PD)patients every 4 months, determining the presence of HMCs in culture (completing 129 studies in total). We isolated mesothelial cells from nocturnal PE and cultured them ex vivo in T-25 flasks. Cell morphology was estimated using the May-Grünwald/Giemsa method. We also examined the histories of a large patient group to determine HMCs directly in PE, and we evaluated 4 of those patients (6%) who showed persistent HMCs. In 10 of 32 prospectively studied patients, we found HMCs during the culture phase. The cells appeared in the first evaluation in 4 patients and in subsequent cultures in the remaining 6 patients. Ultrafiltration (UF) and solute transport capacity in the 10 patients were similar to those of patients who did not show HMCs. Demographic parameters were not different between the two groups. None of the prospectively studied patients showed any clinical or peritoneal functional abnormality during the study. Cultures performed after the observation of HMCs showed very poor growth capacity. The evolution of the 4 patients in the historic group occurred as follows: We 1 patient transferred to hemodialysis 2 years after the observation of HMCs. 1 patient died of an unrelated cause after 1 year on PD. 1 patient received a successful kidney graft 5 years after the observation of HMCs. 1 patient developed type I UF failure 10 years after the first observation.

Long daily hemodialysis sessions correct systemic complications of oxalosis prior to combined liver-kidney transplantation: case report.

An 18-year-old woman diagnosed with piridoxine-resistent primary hyperoxaluria type 1 (PH-1) and progressive renal insufficiency complicated with acute renal failure of obstructive origin who developed systemic oxalosis affecting the heart (cardiomyopathy), the skin (cutaneous ulcers) and vascular system (lower limb ischemia, as well as pulmonary and cerebral microcirculatory blockage resulting in pulmonary hemorrhage and tonic-clonic general seizures. As conventional hemodialysis (HD) or peritoneal dialysis (PD) are unable to eliminate enough oxalate to avoid a continuous positive balance, long daily sessions (6-7 h) of high-flux hemodialysis (highly permeable polyamide membrane of 2.1 m2) for 67 consecutive days normalized blood oxalate levels and reversed the systemic complications secondary to the calcium oxalate crystals deposit. The patient underwent a combined liver-kidney transplantation and has progressed well to the present time. The most important factors in PH-1 treatment are analyzed. Even though combined liver-kidney transplantation is the treatment of choice and should be performed before the glomerular filtrate rate (GFR) falls below 25 mL/min/1.73 m2, intensive HD becomes necessary to prevent oxalosis in the face of acute renal failure. Also, as our case shows, intensive HD can achieve a negative oxalate balance and reverse both the systemic lesions and the oxalate deposits.

Día a día: efemérides comentadas para los Centros Educacionales / From day to day: daily record comments for teaching centers

Inmersos en la actual batalla de ideas y en aras de contribuir al logro de una cultura general e integral se realizó este trabajo. Su objetivo es contribuir al incremento de materiales didácticos para una formación político–ideológica de los estudiantes, con vistas a una mejor proyección cultural integral en el desempeño de su profesión. Consiste en un libro que brinda información sobre hechos ocurridos en diferentes ramas del saber humano y esferas de la vida del hombre, en cada uno de los días del año. Abarca fecha de nacimiento y muerte de personalidades, hechos en el ámbito histórico, científico-técnico y cultural, fundamentalmente de Cuba; también se incluyen otros acontecimientos ocurridos en el mundo que tuvieron repercusión en nuestro país. Consta de 731 efemérides comentadas, acompañadas, algunas de ellas, de información visual. El trabajo aporta información a los estudiantes y contribuye a subsanar las insuficiencias informativas(AU)