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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Our seminar has been developed over decades and represents the evolution of regular case discussions into case-centered anatomical demonstrations&#46; These have as the main ingredient the cross-physical examination of participants and instructors&#46; As a result&#44; our clinical anatomy seminars are participative rather than theoretical and differ from the traditional teaching of anatomy as taught in lectures&#44; books&#44; the dissection room or the computer screen&#44; all of which may enhance the worth of the seminar but none of which can replace it&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Almost four decades ago one of us &#40;JJC&#41;&#44; perhaps influenced by his 2-year anatomy assistantship while in medical school followed by unique conducive conditions found at his new workplace &#40;the Boston Veterans Administration Medical Center&#41;&#44; became involved in studies of bursae and tendons&#46; This interest&#44; sparse at the time&#44; must have caused curiosity as he was invited to give Meet the Professor sessions on regional pain syndromes at the annual meetings of the American College of Rheumatology &#40;ACR&#41;&#46; These sessions were held twice each meeting in 3-year cycles&#44; where Dr&#46; Joseph Biundo from New Orleans who is an expert in both rheumatology and rehabilitation medicine was the alternate speaker&#46; The interest of the attendants&#44; of which approximately 2&#47;3 were rheumatologists in practice and 1&#47;3 fellows from around the world&#44; was as obvious as was their unfamiliarity with the regional anatomy being discussed&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">With this ever more clear perception becoming an obsession JJC invited a former fellow &#40;RAK&#41; who had developed skills in rheumatology education to team up with him hoping to move beyond the regional pain syndromes and enter the unchartered field of rheumatologic clinical anatomy&#46; The question was how to do it&#63; Memories of the dissection room&#44; the research on bursae and tendons&#44; the popular sessions at the ACR and medical education skills&#44; all in combination&#44; suddenly delivered the answer&#46; Cases such as those previously used at the ACR Meet the Professor sessions on regional pain syndromes would be used as a springboard to teach regional anatomy of the musculoskeletal system&#46; And once immersed into the regional anatomy accessible relevant structures would be explored in the instructors&#8217; and participants&#8217; bodies&#46; For two summers we practiced this format with the help of fellows from the Boston programs and once we felt prepared we proposed the seminar to the ACR program committee&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">At the ACR</span><p id="par0020" class="elsevierStylePara elsevierViewall">Our first presentation was at the San Diego meeting in 2005&#46; There were two 2-hour workshops titled &#8220;Anatomical basis of rheumatologic examination&#46; Part 1 &#40;upper extremity and cervical spine&#41; and Part 2 &#40;lumbar spine and lower extremity&#41;&#46; They were well received and have since been given yearly to the present&#46; Two years ago JJC was replaced by Pablo Villase&#241;or-Ovies&#44; coordinator of the Mexican Group of Clinical Anatomy &#40;GMAC&#41;&#44; and he and 4 additional GMAC members now serve as demonstration subjects&#46; There has been some reluctance at the ACR&#44; theirs and ours&#44; to name these seminars as they should&#58; rheumatologic clinical anatomy&#46; But this may soon change&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">In Mexico</span><p id="par0025" class="elsevierStylePara elsevierViewall">In parallel with our ACR activities GMAC was created in Mexico 4 years ago&#44; became a recognized activity of the Mexican College of Rheumatology in 2009&#44; and from its inception has acquired a surprising momentum in Mexico and beyond&#46; GMAC was born as a response to a clear need&#46; In 2007 JJC gave 7 clinical anatomy seminars for all rheumatology fellows in Mexico&#44; 6 in Mexico City and 1 in Guadalajara&#46; The duration of these seminars was 7<span class="elsevierStyleHsp" style=""></span>hours&#46; Each seminar was preceded by a one-to-one&#44; 20-question practical anatomy examination put together by JJC and reviewed by RAK who made corrections and generally found it &#8220;too easy&#8221;&#46; The results of this examination&#44; which were not reported individually to the participants or the department heads&#44; were dismal&#46; Concerned by this deficit two of the current GMAC instructors&#44; Jos&#233; Eduardo Navarro-Zarza and Pablo Villase&#241;or-Ovies&#44; who were among the examined fellows&#44; pressed JJC to start a training course in Mexico&#46; This was done and we had 4-hour training sessions every Saturday morning during 2009&#8211;2011&#46; At present similar sessions take place about twice monthly&#46; In February 2011 a 161-question practical examination&#44; administered by RAK&#44; was used to self-certify the members of our growing group&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Content of the Seminars</span><p id="par0030" class="elsevierStylePara elsevierViewall">Our seminars predominantly deal with regional limb anatomy&#46; Discussed cases&#44; as will be shown in this volume of <span class="elsevierStyleSmallCaps">Reumatolog&#237;a Cl&#237;nica</span>&#44; could be familiar conditions such as a trigger finger or a rheumatoid tenosynovitis&#44; or uncommon but nevertheless important in differential diagnoses such as an axillary nerve neuropathy masquerading as a rotator cuff tendinopathy or a tibial nerve neuroma in the medial retromalleolar space masquerading as a Morton&#39;s neuroma&#46; These cases emphasize an important concept&#58; rheumatologists should not only be internists with a special interest in the musculoskeletal system but also in the nervous system and the vascular system&#46; The chapter arrangement in this volume follows the actual sequence used in our workshops&#46; It begins in the hand and ends in the foot&#46; Emphasis is placed on the soft tissues rather than in the joints&#46; Skin creases&#44; the superficial and deep fascia&#44; specialized dense connective tissues such as pulleys&#44; muscles&#44; tendons&#44; ligaments and bursae receive most of the attention&#46; Neuropathies and ischemic processes that are known to mimic musculoskeletal conditions are interspersed here and there&#46; Injection techniques are not a main subject in our workshop&#46; However&#44; procedures are discussed to emphasize the practical importance of knowing anatomy and as a tactic to maintain the participant&#39;s interest&#46; We shy away from a deep discussion of the presented cases and in particular&#44; the discussion of therapies&#46; Our business is clinical anatomy&#46; We dislike time limitations and prefer&#44; if possible&#44; workshops that extend over 7&#8211;8<span class="elsevierStyleHsp" style=""></span>hours with minor breaks for a sandwich or coffee&#44; or even several days like the one we had in Montevideo&#44; Uruguay&#44; under the joint sponsorship of the &#8220;Sociedad Uruguaya de Reumatolog&#237;a&#8221; and the &#8220;Universidad de la Rep&#250;blica&#8221;&#46; Five members of our group and the majority of rheumatologists of Uruguay attended this seminar&#46; Our incursions in spine anatomy have been sparse and we prefer leaving the bulk of this area to people better qualified than us&#46; It is our hope that rheumatologists with special knowledge in spinal conditions will address this challenge&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Nothing Static About Clinical Anatomy</span><p id="par0035" class="elsevierStylePara elsevierViewall">Skills are being constantly perfected and original observations are often made&#46; This is because we view anatomy with the eye of the clinician&#46; As recent examples we are able to recognize by palpation the insertional tendon of the 1st dorsal interosseous and in doing so&#44; understand the flexor action of this muscle on the metacarpophalangeal joint&#59; we learned to identity the extensor lamina and in this way appreciate the lateral band displacement that occurs during proximal interphalangeal joint flexion&#59; we learned to identify the intersection site in the dorsal forearm where the tendons from the 1st dorsal tunnel cross the underlying tendons of the 2nd dorsal tunnel&#59; and we learned to palpate the coracohumeral ligament in normals and feel its swelling in early frozen shoulder&#46; What a pleasure it is to be able to understand musculoskeletal pathophysiology at the level of orthopedic surgeons&#44; MRI radiologists&#44; and ultrasonography-enabled rheumatologists&#33; And all of this by using our unaided sight and touch&#33;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Spread of the Seminars &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Since 2009 clinical anatomy seminars were given several times in Mexico&#44; in 7 Latin American countries and now in Spain and the USA&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Most of these seminars were preceded by a practical anatomy examination with results quite similar to those of the Mexican fellows&#8217; in 2007&#46; The questions are worded according to the anatomical nomenclature used at a given site&#46; We have been amazed that the old nomenclature&#44; which precedes the Nomina Anatomica and the more recent Terminologia Anatomica&#44; is still in use in about 50&#37; of sites we visited and even at a given site it may be used by the older participants while the younger ones learned anatomy according to the Nomina&#46; One of the papers in this issue of Reumatologia Cl&#237;nica addresses this issue&#46; A heavy seminars program is ongoing in 2012 including 6 in Latin America &#40;3 in Argentina&#44; 2 in Brazil&#44; 1 in Guatemala&#41;&#44; plus 1 in Spain and 1 in the USA at an academic center&#46; The most extraordinary seminar was the one in Manaus&#44; Brazil&#44; at the Federal University of Amazonas&#44; with an exterior temperature of 37<span class="elsevierStyleHsp" style=""></span>&#176;C and high humidity&#33; The ACR workshops&#44; having a total duration of 4<span class="elsevierStyleHsp" style=""></span>hours and without a complete overlap of attendees between the 1st and 2nd halves&#44; necessitate modification of the usual seminar length and goals and in essence provide attendees a sampling of the whole&#46; Currently there are 7 Mexican GMAC instructors including JJC&#46; RAK is an ad-hoc instructor when the seminar is given in English such as the one we gave in Cancun in February 2011 for the Canadian rheumatology fellows&#44; the one in the USA&#44; and the ACR workshops&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Educational Activities</span><p id="par0045" class="elsevierStylePara elsevierViewall">In addition to the seminars GMAC is involved in educational activities together with the Mexican School of Ultrasonography&#44; which in Mexico has a legal standing under the aegis of the Mexican College of Rheumatology&#44; and the department of Anatomy of the National University of Mexico &#40;UNAM&#41;&#46; We have had 3 combined sessions of lectures&#44; dissection&#44; US in fresh cadavers and blind and guided procedures in fresh cadavers&#46; One was devoted to the hand&#44; other to the shoulder and the third to peripheral nerves&#46; These sessions have been very fruitful for the 3 parties involved&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">When Should Clinical Musculoskeletal Anatomy be Taught&#63;</span><p id="par0050" class="elsevierStylePara elsevierViewall">We believe that an intensive clinical anatomy course should be an integral part of rheumatology fellows training&#46; This instruction would be ideal at the beginning of training and would take about a week&#46; The teaching could be provided by arrangement through the local rheumatism society&#44; university or rheumatology board&#46; However&#44; one of GMAC&#39;s goals is that every rheumatology training program in Mexico has its own clinical anatomist on board&#46; This can be achieved without a drain of resources by the training of current staff irrespective of this person&#39;s interests&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Who is Fit to Become an Instructor in Rheumatologis Clinical Anatomy&#63;</span><p id="par0055" class="elsevierStylePara elsevierViewall">We would like to submit that every academic rheumatologist would benefit from becoming a clinical anatomist&#46; His or her skills in physical examination would be enhanced and so the quality of their clinical teaching&#46; Those who had training in ultrasonography should try it too&#46; Ultrasonography is often learned through the probe and regional examination usually begins after a landmark has been identified&#44; i&#46;e&#46; the coracoid in shoulder examinations&#46; But the coracoid is readily palpable&#46; This brings the issue of reliability&#46; Is a landmark more reliably identified when looked at the screen or when seen or touched&#63; The answer is obvious&#58; our bare senses are best to identify what can be seen or touched&#46; However&#44; US is best where our senses fall short&#46; This is why every rheumatologist&#44; including our ultrasonographist colleagues&#44; would benefit from having training in clinical anatomy&#46; Our group may serve as an example&#46; At GMAC&#44; of 8 current instructors all are rheumatologists&#59; of these&#44; 3 are interested in autoimmune disease and one of them&#44; in addition&#44; is an ultrasonographist&#59; 1 is head of an US department&#59; 2 are general rheumatologists and 1 of them is a US trainee&#59; 1 is interested in spondyloarthropathies and 1 is a general rheumatologist with a particular interest on rheumatology education&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Research</span><p id="par0060" class="elsevierStylePara elsevierViewall">An important activity of GMAC is research&#46; Two large projects are underway and partial results have been presented at the 2011 ACR Meeting&#46; One is an analysis of the pre-seminar examinations&#46; Early results have shown that we rheumatologists know the least about anatomical structures that we should know the most&#44; i&#46;e&#46; the hand and the shoulder&#46; The second study is a multinational Delphi analysis of the anatomical items that rheumatologists should know as a component of a proficient practice in rheumatology&#46; Several additional studies are in earlier stages&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financing the Program</span><p id="par0065" class="elsevierStylePara elsevierViewall">An ILAR grant allowed us to visit 5 Latin American countries in 2010 and purchase needed equipment such as a camera and a projector for displaying the didactic slides&#46; We would pay the plane tickets off this grant and modest lodging and meals would be provided by the local rheumatism societies&#46; No honoraria were charged during&#44; before&#44; or after that 1-year support&#46; More recently we have been traveling by invitation of local societies&#46; Industry will finance the upcoming workshop in Spain&#46; Given the opportunity&#44; additional industry support will be welcomed&#46; However we understand that the very nature of our endeavor&#44; which insulates us from ethical problems&#44; at the same time makes us unappealing to potential sponsors&#46; Definitely&#44; business class tickets and 5 star hotels are not a priority to clinical anatomists&#46; Our reward is that exhilarating feeling that emanates from our instructors-participants interaction&#46; In addition&#44; there is a sense of discovery in being able to identify parts of the musculoskeletal system that previously were just names and abstract concepts&#46; For us&#44; the instructors&#44; there is a distinct feeling that we are addressing a real need in our profession&#46; Last but not the least&#44; we are quite aware that we are contributing to restore humanism to medicine&#46; Patients feel reassured and even delighted when they are subjected to a skillful examination and sense a purpose in each palpation and in every motion the rheumatologist evaluates&#46; This is the greatest ultimate reward we seek for our anatomical adventures&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "identificador" => "xpalclavsec111418"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres124137"
          "titulo" => "Resumen"
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec111419"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "At the ACR"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "In Mexico"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Content of the Seminars"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Nothing Static About Clinical Anatomy"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Spread of the Seminars &#40;Table 1&#41;"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Additional Educational Activities"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "When Should Clinical Musculoskeletal Anatomy be Taught&#63;"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Who is Fit to Become an Instructor in Rheumatologis Clinical Anatomy&#63;"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Research"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Financing the Program"
        ]
        14 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflict of Interest"
        ]
        15 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-10-02"
    "fechaAceptado" => "2012-10-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec111418"
          "palabras" => array:3 [
            0 => "Clinical anatomy"
            1 => "Rheumatology training"
            2 => "Physical examination"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec111419"
          "palabras" => array:3 [
            0 => "Anatom&#237;a cl&#237;nica"
            1 => "Entrenamiento reumatol&#243;gico"
            2 => "Examen f&#237;sico"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The current issue of <span class="elsevierStyleSmallCaps">Reumatolog&#237;a Cl&#237;nica</span> is devoted to the method of teaching clinical anatomy as it applies to rheumatology&#46; This method was developed as a response to a perceived need&#46; It is our belief that rheumatologists are at present insufficiently trained in clinical anatomy&#46; As a result&#44; our diagnostic skills may fall short of their potential&#46; Recent rheumatologic literature shows a vertiginous growth of musculoskeletal ultrasonography&#46; In contrast to ultrasound&#44; however&#44; skilled&#44; anatomy-based inspection and palpation can be mastered by all and applied in the care of all patients&#46; It is our hope that clinical musculoskeletal anatomy will one day be a basic component in rheumatology training programs&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Este n&#250;mero de <span class="elsevierStyleSmallCaps">Reumatolog&#237;a Cl&#237;nica</span> se dedica a la difusi&#243;n de un m&#233;todo de ense&#241;anza de la anatom&#237;a cl&#237;nica para reumat&#243;logos&#46; No se trata de una propuesta sino m&#225;s bien de una respuesta a una carencia que percibimos&#44; a trav&#233;s de muchos a&#241;os y hasta el presente&#44; en reumat&#243;logos de distintos pa&#237;ses y continentes&#46; La ultrasonograf&#237;a musculoesquel&#233;tica&#44; a pesar de su extraordinaria importancia y creciente difusi&#243;n&#44; impactar&#225; poco en esta carencia&#46; Es m&#225;s&#44; a menos que hagamos un esfuerzo consciente de educaci&#243;n puede llegar a agravarla por atrofia por desuso de nuestros m&#250;sculos cl&#237;nicos&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Argentina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ecuador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">El Salvador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Guatemala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mexico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uruguay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total seminars per year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                    0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Ultrasound imaging&#58; a rheumatologist&#39;s dream"
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Development of the Seminar
Desarrollo del seminario
Robert A. Kalisha,b, Juan J. Canosoa,c,
Autor para correspondencia
jcanoso@gmail.com

Corresponding author.
a Tufts University School of Medicine, Boston, MA, USA
b Rheumatology Division, Tufts Medical Center, Boston, MA, USA
c Centro Médico ABC, México, DF, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Our seminar has been developed over decades and represents the evolution of regular case discussions into case-centered anatomical demonstrations&#46; These have as the main ingredient the cross-physical examination of participants and instructors&#46; As a result&#44; our clinical anatomy seminars are participative rather than theoretical and differ from the traditional teaching of anatomy as taught in lectures&#44; books&#44; the dissection room or the computer screen&#44; all of which may enhance the worth of the seminar but none of which can replace it&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Almost four decades ago one of us &#40;JJC&#41;&#44; perhaps influenced by his 2-year anatomy assistantship while in medical school followed by unique conducive conditions found at his new workplace &#40;the Boston Veterans Administration Medical Center&#41;&#44; became involved in studies of bursae and tendons&#46; This interest&#44; sparse at the time&#44; must have caused curiosity as he was invited to give Meet the Professor sessions on regional pain syndromes at the annual meetings of the American College of Rheumatology &#40;ACR&#41;&#46; These sessions were held twice each meeting in 3-year cycles&#44; where Dr&#46; Joseph Biundo from New Orleans who is an expert in both rheumatology and rehabilitation medicine was the alternate speaker&#46; The interest of the attendants&#44; of which approximately 2&#47;3 were rheumatologists in practice and 1&#47;3 fellows from around the world&#44; was as obvious as was their unfamiliarity with the regional anatomy being discussed&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">With this ever more clear perception becoming an obsession JJC invited a former fellow &#40;RAK&#41; who had developed skills in rheumatology education to team up with him hoping to move beyond the regional pain syndromes and enter the unchartered field of rheumatologic clinical anatomy&#46; The question was how to do it&#63; Memories of the dissection room&#44; the research on bursae and tendons&#44; the popular sessions at the ACR and medical education skills&#44; all in combination&#44; suddenly delivered the answer&#46; Cases such as those previously used at the ACR Meet the Professor sessions on regional pain syndromes would be used as a springboard to teach regional anatomy of the musculoskeletal system&#46; And once immersed into the regional anatomy accessible relevant structures would be explored in the instructors&#8217; and participants&#8217; bodies&#46; For two summers we practiced this format with the help of fellows from the Boston programs and once we felt prepared we proposed the seminar to the ACR program committee&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">At the ACR</span><p id="par0020" class="elsevierStylePara elsevierViewall">Our first presentation was at the San Diego meeting in 2005&#46; There were two 2-hour workshops titled &#8220;Anatomical basis of rheumatologic examination&#46; Part 1 &#40;upper extremity and cervical spine&#41; and Part 2 &#40;lumbar spine and lower extremity&#41;&#46; They were well received and have since been given yearly to the present&#46; Two years ago JJC was replaced by Pablo Villase&#241;or-Ovies&#44; coordinator of the Mexican Group of Clinical Anatomy &#40;GMAC&#41;&#44; and he and 4 additional GMAC members now serve as demonstration subjects&#46; There has been some reluctance at the ACR&#44; theirs and ours&#44; to name these seminars as they should&#58; rheumatologic clinical anatomy&#46; But this may soon change&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">In Mexico</span><p id="par0025" class="elsevierStylePara elsevierViewall">In parallel with our ACR activities GMAC was created in Mexico 4 years ago&#44; became a recognized activity of the Mexican College of Rheumatology in 2009&#44; and from its inception has acquired a surprising momentum in Mexico and beyond&#46; GMAC was born as a response to a clear need&#46; In 2007 JJC gave 7 clinical anatomy seminars for all rheumatology fellows in Mexico&#44; 6 in Mexico City and 1 in Guadalajara&#46; The duration of these seminars was 7<span class="elsevierStyleHsp" style=""></span>hours&#46; Each seminar was preceded by a one-to-one&#44; 20-question practical anatomy examination put together by JJC and reviewed by RAK who made corrections and generally found it &#8220;too easy&#8221;&#46; The results of this examination&#44; which were not reported individually to the participants or the department heads&#44; were dismal&#46; Concerned by this deficit two of the current GMAC instructors&#44; Jos&#233; Eduardo Navarro-Zarza and Pablo Villase&#241;or-Ovies&#44; who were among the examined fellows&#44; pressed JJC to start a training course in Mexico&#46; This was done and we had 4-hour training sessions every Saturday morning during 2009&#8211;2011&#46; At present similar sessions take place about twice monthly&#46; In February 2011 a 161-question practical examination&#44; administered by RAK&#44; was used to self-certify the members of our growing group&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Content of the Seminars</span><p id="par0030" class="elsevierStylePara elsevierViewall">Our seminars predominantly deal with regional limb anatomy&#46; Discussed cases&#44; as will be shown in this volume of <span class="elsevierStyleSmallCaps">Reumatolog&#237;a Cl&#237;nica</span>&#44; could be familiar conditions such as a trigger finger or a rheumatoid tenosynovitis&#44; or uncommon but nevertheless important in differential diagnoses such as an axillary nerve neuropathy masquerading as a rotator cuff tendinopathy or a tibial nerve neuroma in the medial retromalleolar space masquerading as a Morton&#39;s neuroma&#46; These cases emphasize an important concept&#58; rheumatologists should not only be internists with a special interest in the musculoskeletal system but also in the nervous system and the vascular system&#46; The chapter arrangement in this volume follows the actual sequence used in our workshops&#46; It begins in the hand and ends in the foot&#46; Emphasis is placed on the soft tissues rather than in the joints&#46; Skin creases&#44; the superficial and deep fascia&#44; specialized dense connective tissues such as pulleys&#44; muscles&#44; tendons&#44; ligaments and bursae receive most of the attention&#46; Neuropathies and ischemic processes that are known to mimic musculoskeletal conditions are interspersed here and there&#46; Injection techniques are not a main subject in our workshop&#46; However&#44; procedures are discussed to emphasize the practical importance of knowing anatomy and as a tactic to maintain the participant&#39;s interest&#46; We shy away from a deep discussion of the presented cases and in particular&#44; the discussion of therapies&#46; Our business is clinical anatomy&#46; We dislike time limitations and prefer&#44; if possible&#44; workshops that extend over 7&#8211;8<span class="elsevierStyleHsp" style=""></span>hours with minor breaks for a sandwich or coffee&#44; or even several days like the one we had in Montevideo&#44; Uruguay&#44; under the joint sponsorship of the &#8220;Sociedad Uruguaya de Reumatolog&#237;a&#8221; and the &#8220;Universidad de la Rep&#250;blica&#8221;&#46; Five members of our group and the majority of rheumatologists of Uruguay attended this seminar&#46; Our incursions in spine anatomy have been sparse and we prefer leaving the bulk of this area to people better qualified than us&#46; It is our hope that rheumatologists with special knowledge in spinal conditions will address this challenge&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Nothing Static About Clinical Anatomy</span><p id="par0035" class="elsevierStylePara elsevierViewall">Skills are being constantly perfected and original observations are often made&#46; This is because we view anatomy with the eye of the clinician&#46; As recent examples we are able to recognize by palpation the insertional tendon of the 1st dorsal interosseous and in doing so&#44; understand the flexor action of this muscle on the metacarpophalangeal joint&#59; we learned to identity the extensor lamina and in this way appreciate the lateral band displacement that occurs during proximal interphalangeal joint flexion&#59; we learned to identify the intersection site in the dorsal forearm where the tendons from the 1st dorsal tunnel cross the underlying tendons of the 2nd dorsal tunnel&#59; and we learned to palpate the coracohumeral ligament in normals and feel its swelling in early frozen shoulder&#46; What a pleasure it is to be able to understand musculoskeletal pathophysiology at the level of orthopedic surgeons&#44; MRI radiologists&#44; and ultrasonography-enabled rheumatologists&#33; And all of this by using our unaided sight and touch&#33;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Spread of the Seminars &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Since 2009 clinical anatomy seminars were given several times in Mexico&#44; in 7 Latin American countries and now in Spain and the USA&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Most of these seminars were preceded by a practical anatomy examination with results quite similar to those of the Mexican fellows&#8217; in 2007&#46; The questions are worded according to the anatomical nomenclature used at a given site&#46; We have been amazed that the old nomenclature&#44; which precedes the Nomina Anatomica and the more recent Terminologia Anatomica&#44; is still in use in about 50&#37; of sites we visited and even at a given site it may be used by the older participants while the younger ones learned anatomy according to the Nomina&#46; One of the papers in this issue of Reumatologia Cl&#237;nica addresses this issue&#46; A heavy seminars program is ongoing in 2012 including 6 in Latin America &#40;3 in Argentina&#44; 2 in Brazil&#44; 1 in Guatemala&#41;&#44; plus 1 in Spain and 1 in the USA at an academic center&#46; The most extraordinary seminar was the one in Manaus&#44; Brazil&#44; at the Federal University of Amazonas&#44; with an exterior temperature of 37<span class="elsevierStyleHsp" style=""></span>&#176;C and high humidity&#33; The ACR workshops&#44; having a total duration of 4<span class="elsevierStyleHsp" style=""></span>hours and without a complete overlap of attendees between the 1st and 2nd halves&#44; necessitate modification of the usual seminar length and goals and in essence provide attendees a sampling of the whole&#46; Currently there are 7 Mexican GMAC instructors including JJC&#46; RAK is an ad-hoc instructor when the seminar is given in English such as the one we gave in Cancun in February 2011 for the Canadian rheumatology fellows&#44; the one in the USA&#44; and the ACR workshops&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Educational Activities</span><p id="par0045" class="elsevierStylePara elsevierViewall">In addition to the seminars GMAC is involved in educational activities together with the Mexican School of Ultrasonography&#44; which in Mexico has a legal standing under the aegis of the Mexican College of Rheumatology&#44; and the department of Anatomy of the National University of Mexico &#40;UNAM&#41;&#46; We have had 3 combined sessions of lectures&#44; dissection&#44; US in fresh cadavers and blind and guided procedures in fresh cadavers&#46; One was devoted to the hand&#44; other to the shoulder and the third to peripheral nerves&#46; These sessions have been very fruitful for the 3 parties involved&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">When Should Clinical Musculoskeletal Anatomy be Taught&#63;</span><p id="par0050" class="elsevierStylePara elsevierViewall">We believe that an intensive clinical anatomy course should be an integral part of rheumatology fellows training&#46; This instruction would be ideal at the beginning of training and would take about a week&#46; The teaching could be provided by arrangement through the local rheumatism society&#44; university or rheumatology board&#46; However&#44; one of GMAC&#39;s goals is that every rheumatology training program in Mexico has its own clinical anatomist on board&#46; This can be achieved without a drain of resources by the training of current staff irrespective of this person&#39;s interests&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Who is Fit to Become an Instructor in Rheumatologis Clinical Anatomy&#63;</span><p id="par0055" class="elsevierStylePara elsevierViewall">We would like to submit that every academic rheumatologist would benefit from becoming a clinical anatomist&#46; His or her skills in physical examination would be enhanced and so the quality of their clinical teaching&#46; Those who had training in ultrasonography should try it too&#46; Ultrasonography is often learned through the probe and regional examination usually begins after a landmark has been identified&#44; i&#46;e&#46; the coracoid in shoulder examinations&#46; But the coracoid is readily palpable&#46; This brings the issue of reliability&#46; Is a landmark more reliably identified when looked at the screen or when seen or touched&#63; The answer is obvious&#58; our bare senses are best to identify what can be seen or touched&#46; However&#44; US is best where our senses fall short&#46; This is why every rheumatologist&#44; including our ultrasonographist colleagues&#44; would benefit from having training in clinical anatomy&#46; Our group may serve as an example&#46; At GMAC&#44; of 8 current instructors all are rheumatologists&#59; of these&#44; 3 are interested in autoimmune disease and one of them&#44; in addition&#44; is an ultrasonographist&#59; 1 is head of an US department&#59; 2 are general rheumatologists and 1 of them is a US trainee&#59; 1 is interested in spondyloarthropathies and 1 is a general rheumatologist with a particular interest on rheumatology education&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Research</span><p id="par0060" class="elsevierStylePara elsevierViewall">An important activity of GMAC is research&#46; Two large projects are underway and partial results have been presented at the 2011 ACR Meeting&#46; One is an analysis of the pre-seminar examinations&#46; Early results have shown that we rheumatologists know the least about anatomical structures that we should know the most&#44; i&#46;e&#46; the hand and the shoulder&#46; The second study is a multinational Delphi analysis of the anatomical items that rheumatologists should know as a component of a proficient practice in rheumatology&#46; Several additional studies are in earlier stages&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financing the Program</span><p id="par0065" class="elsevierStylePara elsevierViewall">An ILAR grant allowed us to visit 5 Latin American countries in 2010 and purchase needed equipment such as a camera and a projector for displaying the didactic slides&#46; We would pay the plane tickets off this grant and modest lodging and meals would be provided by the local rheumatism societies&#46; No honoraria were charged during&#44; before&#44; or after that 1-year support&#46; More recently we have been traveling by invitation of local societies&#46; Industry will finance the upcoming workshop in Spain&#46; Given the opportunity&#44; additional industry support will be welcomed&#46; However we understand that the very nature of our endeavor&#44; which insulates us from ethical problems&#44; at the same time makes us unappealing to potential sponsors&#46; Definitely&#44; business class tickets and 5 star hotels are not a priority to clinical anatomists&#46; Our reward is that exhilarating feeling that emanates from our instructors-participants interaction&#46; In addition&#44; there is a sense of discovery in being able to identify parts of the musculoskeletal system that previously were just names and abstract concepts&#46; For us&#44; the instructors&#44; there is a distinct feeling that we are addressing a real need in our profession&#46; Last but not the least&#44; we are quite aware that we are contributing to restore humanism to medicine&#46; Patients feel reassured and even delighted when they are subjected to a skillful examination and sense a purpose in each palpation and in every motion the rheumatologist evaluates&#46; This is the greatest ultimate reward we seek for our anatomical adventures&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "titulo" => "Nothing Static About Clinical Anatomy"
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          "titulo" => "Spread of the Seminars &#40;Table 1&#41;"
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          "titulo" => "When Should Clinical Musculoskeletal Anatomy be Taught&#63;"
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          "titulo" => "Who is Fit to Become an Instructor in Rheumatologis Clinical Anatomy&#63;"
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            1 => "Entrenamiento reumatol&#243;gico"
            2 => "Examen f&#237;sico"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The current issue of <span class="elsevierStyleSmallCaps">Reumatolog&#237;a Cl&#237;nica</span> is devoted to the method of teaching clinical anatomy as it applies to rheumatology&#46; This method was developed as a response to a perceived need&#46; It is our belief that rheumatologists are at present insufficiently trained in clinical anatomy&#46; As a result&#44; our diagnostic skills may fall short of their potential&#46; Recent rheumatologic literature shows a vertiginous growth of musculoskeletal ultrasonography&#46; In contrast to ultrasound&#44; however&#44; skilled&#44; anatomy-based inspection and palpation can be mastered by all and applied in the care of all patients&#46; It is our hope that clinical musculoskeletal anatomy will one day be a basic component in rheumatology training programs&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Este n&#250;mero de <span class="elsevierStyleSmallCaps">Reumatolog&#237;a Cl&#237;nica</span> se dedica a la difusi&#243;n de un m&#233;todo de ense&#241;anza de la anatom&#237;a cl&#237;nica para reumat&#243;logos&#46; No se trata de una propuesta sino m&#225;s bien de una respuesta a una carencia que percibimos&#44; a trav&#233;s de muchos a&#241;os y hasta el presente&#44; en reumat&#243;logos de distintos pa&#237;ses y continentes&#46; La ultrasonograf&#237;a musculoesquel&#233;tica&#44; a pesar de su extraordinaria importancia y creciente difusi&#243;n&#44; impactar&#225; poco en esta carencia&#46; Es m&#225;s&#44; a menos que hagamos un esfuerzo consciente de educaci&#243;n puede llegar a agravarla por atrofia por desuso de nuestros m&#250;sculos cl&#237;nicos&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">2012&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Argentina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Brazil&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Chile&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ecuador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">El Salvador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Guatemala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mexico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uruguay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total seminars per year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical anatomy&#58; an unmet agenda in rheumatology training"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;A&#46; Kalish"
                            1 => "J&#46;J&#46; Canoso"
                          ]
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                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2007"
                        "volumen" => "34"
                        "paginaInicial" => "1208"
                        "paginaFinal" => "1211"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17552050"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound imaging&#58; a rheumatologist&#39;s dream"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;J&#46; Canoso"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2000"
                        "volumen" => "27"
                        "paginaInicial" => "2063"
                        "paginaFinal" => "2064"
                        "link" => array:1 [
                          0 => array:2 [
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Información del artículo
ISSN: 1699258X
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