232 research outputs found
Taxonomy, allometry, sexual dimorphism, and conservation of the trans-Andean water-snake Helicops danieli Amaral 1937 (Serpentes: Dipsadidae: Hydropsini).
No full textThe extensive lack of knowledge on the morphological aspects of South American water-snakes, includes a poor understanding of phenotypic parameters, intraspecific variation, and conservation of the trans-Andean Helicops species, Helicops danieli Amaral, 1937. For the first time, we provide a multidisciplinary view using key features (e.g., morphology and niche modeling) to improve the taxonomic recognition of this species, as well as describing ontogenetic color changes, allometry, sexual dimorphism, and the conservation status of this poorly studied snake. First, we emended the morphological diagnosis of H. danieli with 23 characters and detected that juvenile tail length is positively related to allometric growth, and that juveniles differ from adults through the presence of the white nuchal collar. Females are larger than males for snout-vent length, whereas males showed proportionally longer tails and smaller head length growth. Suitable areas for H. danieli are restricted to the trans-Andean regions from the Magdalena drainage to the Caribbean coast, which also showed high values of anthropic impacts. Our multidisciplinary approach provided new insights into this South American water snake’s morphology, intraspecific variation, and distribution.The presentation of the authors' names and (or) special characters in the title of the pdf file of the accepted manuscript may differ slightly from what is displayed on the item page. The information in the pdf file of the accepted manuscript reflects the original submission by the author
A tinta do (in)vis?vel : olhares sobre a po?tica da transcria??o nas edi??es de A asa e a serpente, de Vicente Cecim
No full textSubmitted by PPG Letras ([email protected]) on 2018-10-09T17:40:34Z
No. of bitstreams: 1
Tese Danieli dos Santos Pimentel.pdf: 4896329 bytes, checksum: 8fbcf34615980e06f38eda3d7a624cee (MD5)Approved for entry into archive by Sheila Dias ([email protected]) on 2018-10-10T11:51:49Z (GMT) No. of bitstreams: 1
Tese Danieli dos Santos Pimentel.pdf: 4896329 bytes, checksum: 8fbcf34615980e06f38eda3d7a624cee (MD5)Made available in DSpace on 2018-10-10T12:12:57Z (GMT). No. of bitstreams: 1
Tese Danieli dos Santos Pimentel.pdf: 4896329 bytes, checksum: 8fbcf34615980e06f38eda3d7a624cee (MD5)
Previous issue date: 2018-03-28Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPESThis thesis studies the poetics of transcreation in the editions of A asa e a serpente [The Wing and the Serpent] (1979; 1980; 1988; and 2004), from Brazilian writer Vicente Cecim, with the objective of analyzing, from a comparison of the books, how the author?s literary work is carried by the glance of the (in)visible ink. First, it is created a route of the main aspects of the author?s trajectory, in addition to his relationship with contemporary Brazilian literature. In regard to critical reception of his work, diverse opinions are listed based on records present in the initial publication of A asa e a serpente (1979), passing through more specific analysis of Cecim?s creative universe. In conjunction, we discuss the literary composition of Andara?s cycle, which has as vertices, among others, reflections involving the Being and the perception of (in)visible worlds; the imagery of the labyrinth, as an imaginary space and a metalanguage of Vicente Cecim?s writing; the unfinishedness of literary writing itself and silence as a space opened to the creative imagination. In the chapter on theoretical foundation, an explanation is provided on what is the transcreation poetics through the logic of the writer himself, and how that concept suggests means for analyzing the different editions of A asa e a serpente. Lastly, it is outlined a comparison of the editions, resulting in the conclusion that Vicente Cecim delineates a transcreative writing approach centered between the visible and the invisible, culminating in oscillations which become perceptive trough changes in the writing plane and in the graphic project of the books.Cette th?se ?tudie la po?tique de la transcr?ation dans les diff?rentes ?ditions du livre A asa e a serpente (1979, 1980, 1988 et 2004), de l??crivain br?silien Vicente Cecim. L?objectif est d?analyser, ? partir de la comparaison entre les ?ditions, comment se construit l??criture litt?raire de l?auteur par le biais de l?encre (in)visible. Dans un premier temps, on pr?sente un parcours des principaux aspects de la trajectoire de l?auteur, et aussi de sa relation avec la litt?rature br?silienne contemporaine. En ce qui concerne la r?ception critique de son oeuvre, on rassemble des opinions diverses bas?es sur des registres pr?sents dans la premi?re publication de A asa e a serpente (1979), en passant par des analyses plus sp?cifiques l?univers cr?atif de Cecim. De plus, on d?veloppe une ?tude de la composition litt?raire du cycle de Andara, qui a comme vecteurs, entre autres, des r?flexions au sujet de l??tre et des perceptions de mondes (in)visibles, l?image du labyrinthe comme espace imaginaire et du m?talangage de l??criture de Vicente Cecim, l?inachev? de l??criture litt?raire et le silence comme espace ouvert ? l?imagination cr?ative. Dans le chapitre de fondation, on explique ce qu?est la po?tique de la transcr?ation par la logique de l??crivain lui-m?me, et comment ce concept sugg?re les moyens d?analyser les diff?rentes ?ditions de A asa e a serpente. En dernier point, on ?bauche une comparaison entre les ?ditions, ce qui aboutit ? la conclusion selon laquelle Vicente Cecim ?bauche une ?criture transcr?ative qui est centr?e entre le visible et l?invisible. Ceci d?clenche des oscillations qui sont perceptibles ? travers les changements de plan de l??criture et dans le projet graphique des livres.A presente tese estuda a po?tica da transcria??o nas edi??es de A asa e a serpente (1979, 1980, 1988 e 2004), de autoria do escritor brasileiro Vicente Cecim, com o objetivo de analisar, a partir do cotejo entre os livros, como se exerce a escritura liter?ria do autor pelo vi?s da tinta (in)vis?vel. Primeiramente, cria-se um percurso sobre os principais aspectos da trajet?ria do autor, al?m de sua rela??o com a literatura brasileira contempor?nea. No que diz respeito ? recep??o cr?tica de sua obra, elencam-se opini?es diversas com base em registros presentes na publica??o inicial de A asa e a serpente (1979), perpassando por an?lises mais espec?ficas acerca do universo criativo ceciniano. Aliado a isso, discorre-se a respeito da composi??o liter?ria do ciclo de Andara, que tem como v?rtices, dentre outros, reflex?es que envolvem o Ser e as percep??es de mundos (in)vis?veis; a imagem do labirinto, enquanto espa?o imagin?rio e metalinguagem da escrita de Vicente Cecim; o inacabamento da pr?pria escrita liter?ria e o sil?ncio como espa?o aberto ? imagina??o criadora. No cap?tulo de fundamenta??o, explica-se o que ? a po?tica da transcria??o pela l?gica do pr?prio escritor, e de como esse conceito sugere meios de analisar as diferentes edi??es de A asa e a serpente. E, por ?ltimo, delineia-se um cotejo entre as edi??es e A asa e a serpente, que resulta na conclus?o de que Vicente Cecim concebe uma escrita transcriativa que se centra entre o vis?vel e o invis?vel, culminando em oscila??es que s?o percept?veis atrav?s de mudan?as no plano da escrita e no projeto gr?fico dos livro
Ischalia (Telnovia) danieli Bukejs 2017, sp. nov.
No full textIschalia (Telnovia) danieli sp. nov. (Figs 6–12) Type material. Holotype No. C 2490 [GPIH], adult, male. Complete beetle included in small and thin amber piece with approximate dimensions: 22 × 10 × 4 mm. Syninclusions are represented by one stellate fagacean trichome and few small gas vesicles. Type strata. Baltic amber, mid-Eocene to Upper Eocene. Type locality. Yantarny settlement (formerly Palmnicken), Sambian (Samland) Peninsula, the Kaliningrad region, Russia. Etymology. Patronymic, the specific epithet is dedicated to the son of the second author – Daniel Bukejs. Diagnosis. As stated for the new subgenus. Additionally, I. (Telnovia) danieli sp. nov. differs from the similar looking fossil I. (Eupleurida) dohnaturris sp. nov. due to its wider habitus, short apical spur on mesothoracic and metathoracic tibiae, absence of long recumbent pubescence on anterior portions of elytra, shorter median longitudinal carina, and subtrapezoidal scutellar shield. Description. Body length 5.6 mm; maximum body width 2.5 mm; pronotum 0.9 mm long, maximum width 1.2 mm; elytral length 4.3 mm; maximum combined width of elytra (postmedially) 2.5 mm. Body color dark brown; ventral surface, tarsi, palpi, and apical antennomeres apparently lighter in colour. Head, pronotum and elytra sparsely covered with short (about 2× as long as one puncture diameter), semi-erect setae; ventral surface and legs with finer, short, recumbent setae, in denser arrangement than setae on dorsal surface. Head, pronotum and elytra shiny, densely covered with large punctures (2–4× diameter of one eye facet), distance between punctures smaller than diameter of one puncture; pro-, meso-, metasternum, and abdomen with fine and dense punctation. Head transverse, about 2.4× as wide as long, constricted posteriorly; frons slightly convex, inflated at antennal insertions. Compound eyes large, with vertical diameter about 2.2× transverse diameter, slightly convex, reniform; distinctly emarginate on inner margin; glabrous with coarse facets. Antennae 11-segmented, filiform, robust and moderately long, extending to basal one-fourth of elytra, densely pubescent (scape and pedicel with less conspicuous pubescence); scape subcylindrical, 1.6× as long as wide; pedicel nearly quadratic, 1.1× as long as wide, and 0.8× as long as scape; antennomeres 3–10 slightly dilated apically; antennomere 11 tapered, with pointed apex. Relative length ratios of antennomeres 1–11: 14-8-12- 10-10-10-10 -10-8-8-10. Clypeus transverse, rectangular, almost flat; frontoclypeal suture distinct. Maxillary palpus 4-segmented; apical palpomere large, securiform, elongate, about 1.8× as long as wide. Labial palpus 3-segmented, short; apical palpomere distinctly transverse, 1.8× as wide as long, about as long as palpomeres 1–2 combined. Pronotum slightly transverse, about 1.3× as wide as long, distinctly narrower than anterior part of elytra; with short median longitudinal carina in posterior one-sixth of pronotal length and slightly produced posteriorly beyond margin; with two transverse, semicircular impressions in posterior half, and with longitudinal median impression in anterior half. Anterior margin almost straight, shallowly emarginate mesally; lateral margins rounded in anterior half and almost straight posteriorly; posterior margin slightly convex. Anterior angles widely rounded; posterior angles nearly rectangular, vaguely protruding. Scutellar shield large, subtrapezoidal, about 1.5× as long as wide, impunctate, dull, densely covered with fine pubescence, apical margin shallowly emarginate medially. Elytra subparallel-sided, relatively flat, elongate (1.7× as long as combined width), irregularly punctate, completely covering abdomen, with concave anterior margin; humeral calli well-developed, distinctly protruding. Elytra with sutural, discal, lateral discal, and lateral carinae; humeral carinae absent; sutural carinae slightly convex, complete; discal carinae short, distinct in basal one-fourth of elytral length; lateral discal carinae gradually curved toward sutural carinae, becoming obsolete and not fusing with sutural carinae; lateral carinae fine, indistinct, apparently complete. Epipleura well-developed, wide, reaching apex of elytra. Mesosternal ventrite flat, with wide, rounded anterior margin; mesepisternae widely separated by mesosternal ventrite. Disc of metasternal ventrite sligthly convex; metepisterna with nearly straight lateral margins, about 4.8× as long as wide. Metathoracic wings are not visible in examined specimen. Abdomen with five freely articulated, visible ventrites of subequal length. Abdominal sutures straight. Legs moderately long and slender. All coxae transverse; prothoracic coxae apparently contiguous, meso- and metathoracic coxae narrowly separated. Femora and tibiae subequal in length. Tibiae slightly curved; mesothoracic and metathoracic tibiae with thin, short apical spur. Tarsal formula 5-5-4. All penultimate tarsomeres distinctly bilobed. Each metathoracic tarsus about 0.7× as long as metathoracic tibia, each metathoracic tarsomere 1 about as long as metathoracic tarsomeres 2–4 combined. Claws simple, narrow, and symmetrical.Published as part of Bukejs, Andris, 2017, New fossil taxa of Ischalia Pascoe (Coleoptera: Ischaliidae) from Eocene Baltic amber, pp. 229-238 in Zootaxa 4323 (2) on pages 233-237, DOI: 10.11646/zootaxa.4323.2.6, http://zenodo.org/record/89895
Observation of quincunx-shaped and dipole-like flatband states in photonic rhombic lattices without band-touching
No full textWe demonstrate experimentally the existence of compact localized states (CLSs) in a quasi-one-dimensional photonic rhombic lattice in the presence of two distinct refractive-index gradients (i.e., a driven lattice ribbon) acting as external electric fields. Such a lattice is composed of an array of periodically arranged evanescently coupled waveguides, which hosts a perfect flatband that touches both remaining dispersive bands when it is not driven. The external driving is realized by modulating the relative writing beam intensity of adjacent waveguides. We find that a y-gradient set perpendicularly to the ribbon preserves the flatband while removing the band-touching. The undriven dipole-like CLS— which occupies two lattice sites over one unit cell—turns into a quincunx-shaped CLS spanned over two unit cells. Instead, an x-gradient acting parallel to the ribbon yields a Stark ladder of the CLS whose spatial profile is unchanged with respect to the undriven case. We notably find that their superposition leads to Bloch-like oscillations in momentum space. © Author(s) 202011Nsciescopu
Global antiphospholipid syndrome score and anti-Beta-2-glycoprotein I domain for thrombotic risk stratification in antiphospholipid syndrome: a 4-year prospective study
No full textOBJETIVOS: Avaliar prospectivamente o papel do anticorpo anti-domínio I da Beta-2-glicoproteína I (anti-Domínio I) e do Escore Global da Síndrome Antifosfolípide (do inglês Global Antiphospholipid Syndrome Score) (GAPSS) na identificação de pacientes com síndrome antifosfolípide (SAF) com maior risco de apresentar um novo evento trombótico. MÉTODOS: Pacientes com SAF trombótica foram seguidos no período de maio de 2013 a julho de 2017. À admissão no estudo, foram analisados os anticorpos antifosfolípides anticoagulante lúpico, anticardiolipina, anti-ß2-glicoproteína I e antifosfatidilserina-protrombina (aPS/PT) IgG/IgM e anti-Domínio I IgG e foi calculado o GAPSS de cada paciente. RESULTADOS: 44 pacientes (43 ± 10 anos, 89% sexo feminino, 73% SAF primária) foram seguidos por 39 meses (9- 46). Nesse período, quatro novas tromboses ocorreram, duas delas após interrupção do antagonista da vitamina K. Os dois pacientes com evento recorrente apresentaram GAPSS mais alto (20) e eram triplo positivos e anti- Domínio I-positivos; os demais pacientes tiveram GAPSS mais baixo (mediana 10,5, 0-20) e menor taxa de triplo positivos (33%) e de anti-Domínio I-positivos (38%). anti-Domínio I foi associado com alto GAPSS (mediana 19 vs. 7, p < 0,001; correlação de Pearson 0,82, p < 0,001), tripla positividade (83% vs. 4%, p < 0,001) e com o anticorpo aPS/PT (94% vs. 50%, p=0,002). CONCLUSÃO: Os dados mostram uma correlação significativa entre o escore de risco validado GAPSS e o anticorpo antifosfolípide não critério anti-Domínio I. Futuros estudos são necessários, mas os dados permitem especular um papel do anticorpo anti-Domínio I como uma ferramenta de estratificação de risco de novos eventos trombóticos na SAFOBJECTIVE: To prospectively assess the role of anti-Beta-2-glycoprotein I domain I antibody (anti-Domain I) and the Global Antiphospholipid Syndrome Score (GAPSS) in identifying antiphospholipid syndrome (APS) patients at higher risk of a new event. METHODS: Thrombotic APS patients were followed from May 2013 to July 2017. At baseline, we measured lupus anticoagulant, IgG/IgM anticardiolipin, anti-ß2-glycoprotein I, antiphosphatidylserine-prothrombin (aPS/PT) and IgG anti-Domain I, and calculated GAPSS for each patient. RESULTS: 44 patients (43 ± 10 years, 89% female, 73% primary APS) were followed for 39 months (9-46). Four new thromboses occurred, 2 of them after vitamin K antagonist interruption. Recurrent patients presented higher GAPSS (20) and were triple positive and anti-Domain I positive; non-recurrent patients had lower GAPSS (median 10.5, 0-20) and lower ratio of triple (33%) and anti- Domain I positivities (38%). Anti-Domain I was associated with higher GAPSS (median 19 vs. 7, p < 0.001; Pearson correlation 0.82, p < 0.001) and had higher proportion of triple positivity (83% vs. 4%, p < 0.001) and aPS/PT positivity (94% vs. 50%, p=0.002). CONCLUSION: Our data shows a significant correlation between a validated risk score such as GAPSS and the novel antiphospholipid antibody anti-Domain I. Future studies are needed, however one could speculate a role of anti-Domain I as a risk-stratifying tool for thrombotic events in AP
Type I Interferon signature in primary antiphospholipid syndrome
No full textIntrodução: a síndrome antifosfolípide (SAF) primária é uma vasculopatia autoimune mediada por autoanticorpos com trombose como sua principal manifestação clínica. A presença de anticorpos antifosfolípides (aPL), embora relevante para confirmar o diagnóstico, não parece ser suficiente para explicar completamente a fisiopatologia da doença e um segundo gatilho é usualmente necessário. Além das hipóteses de infecções virais e insulto inflamatório como possíveis desencadeantes, parece que os receptores toll like (TLR) e o Interferon (IFN) tipo I são possíveis protagonistas nesse processo, contribuindo para o início da trombose. Recentemente, dois pequenos estudos demonstraram que uma porcentagem relevante de pacientes com SAF primária tem uma regulação positiva de genes IFN em células mononucleares do sangue periférico (CMSP). Entretanto, 20% e 28% dos pacientes nessas duas coortes tiveram anticorpos anti-dsDNA positivos, um autoanticorpo altamente específico do lúpus eritematoso sistêmico (LES). Objetivo: avaliar se os pacientes com SAF bem caracterizados apresentam assinatura para interferon nas células mononucleares periféricas. Secundariamente foram avaliadas possíveis associações clínico laboratoriais com a assinatura de IFN. Métodos: foram selecionados 53 pacientes do sexo feminino com diagnóstico de SAF primária de acordo com os critérios de Sidney, com idade igual ou maior a 18 anos, selecionados no Ambulatório de SAF da Disciplina de Reumatologia do HCFMUSP, pareados por sexo e idade com 50 controles saudáveis. Um terceiro grupo com 29 paciente com antecedente de trombofilias não imunomediadas também foi incluido. Após a coleta de sangue as CMSPs foram purificadas por metodologia de Ficoll. A expressão gênica das CMSPs foi realizada através do TaqMan® RNA Assay em placas TLDA. Foram pesquisados 41 genes induzidos por IFN (GIIs). Uma análise de componente principal (ACP) foi realizada para determinar quais genes deveriam compor a assinatura de IFN. O teste de z-score foi utilizado para normalizar e calcular a assinatura de IFN para cada paciente. O cutoff da assinatura de IFN foi definido por uma curva ROC, e foi escolhido o ponto que maximizava a sensibilidade e especificidade. Características demográficas, clínicas e laboratoriais foram analisadas buscando por associações com a assinatura de IFN. Resultados: 11 genes estavam superexpressos nos pacientes com SAF em comparação aos controles. Após a análise de ACP foram escolhidos 6 genes que representavam mais de 95% do comportamento da amostra para compor a assinatura de IFN: DNAJA1, IFI27, IFI6, IFIT5, MX1 e TYK2. O cutoff encontrado pela curva ROC foi de 3,9 folds (AUC = 0,706, S = 0,49, E = 0,86, VPP = 0,79, VPN = 0,61). A assinatura de IFN estava presente em 49% dos pacientes com SAF primário vs. 14% dos controles saudáveis e 17% dos controles positivos (p < 0,001). Foi encontrada associação entre a assinatura de IFN e uma ocorrência mais precoce do primeiro evento clínico (p = 0,023), e com ocorrência de eventos obstétricos (em especial pré-eclâmpsia, p = 0,032). Não foi econtrada nenhuma associação entre a assinatura de IFN e número de eventos trombóticos, exames laboratoriais, comorbidades, antecedentes familiares de doenças autoimunes, e escores de risco de retrombose. De todos os tratamentos em uso a única associação encontrada foi entre uma menor assinatura de IFN e o uso de estatinas (p = 0,026). Conclusão: esse estudo indica que pacientes com SAF primária bem caracterizados apresentam uma assinatura de IFN tipo I, não observada em outras trombofilias não imunidade-mediadas ou em controles saudáveis. Também demonstrou-se que essa superexpressão de genes regulados por IFN tipo I está associada a um início mais precoce dos eventos e pré-eclâmpsia. Mais estudos são necessários para determinar se este subgrupo de pacientes se beneficiará de intervenções terapêuticas direcionadas à via de sinalização IFN tipo IIntroduction: primary antiphospholipid syndrome (PAPS) is an autoimmune vasculopathy mediated by autoantibodies with thrombosis as its main clinical manifestation. The presence of antiphospholipid antibodies, while relevant to confirm the diagnosis, does not seem to be sufficient to fully explain the pathophysiology and a second trigger is usually needed. Besides the hypotheses of viral infections and inflammatory insult as possible triggers, type I Interferon (IFN) has been pointed as a possible protagonist. Recently, two studies have demonstrated that a relevant percentage of PAPS patients have an up-regulation of IFN genes in peripheral blood mononuclear cells (PBMC). However, 20% and 28% of patients in these 2 cohorts, had antidsDNA positive antibodies, a highly specific Systemic Lupus Erythematosus (SLE) autoantibody. Objective: The aim of this study is to determine the prevalence of type I IFN signature in PBMC of patients with PAPS without specific SLE autoantibodies and search for it with clinical and laboratorial associations. Methods: 53 PAPS patients (according to Sydney´s criteria) were consecutively selected and age-matched with 50 healthy controls. A third group, with non-immune-mediated thrombophilia patients, was also included. The expression of 41 IFN induced genes was analysed using real time quantitative PCR (TaqMan Low Density Array). A principal component analysis (PCA) was used to determine which genes should compose the IFN signature and z-score was calculated. The IFN signature score cut-off was defined with a ROC curve, as the point that maximized both the specificity and sensitivity. Clinical and laboratorial features were analysed searching for associations with IFN signature. Results: 11 IFN genes were highly expressed in primary APS patients. After PCA, 6 genes remained in the IFN signature: DNAJA1, IFIT5, IFI27, MX1, IFI6, TYK2. The ROC cutoff was 3,9 folds (AUC = 0.706, S = 0.49, E = 0.86, VPP = 0.79, VPN = 0.61). The type I IFN signature was present in 49% of patients with primary APS compared to 14.0% of healthy controls and 17% of non-immune-mediated thrombophilia patients (p < 0.0001). The mean IFN score was significantly higher in PAPS patients (4.0 fold higher, p < 0.0001) than in controls. A higher IFN signature was associated with a younger age at the first APS event (p = 0.023) and with the presence of obstetric events, especially with preeclampsia (p = 0.032). There was no association between IFN signature and number of thrombotic events, laboratory exams, comorbidities, family history of autoimmune diseases, and thrombosis risk scores. Treatment with statins was associated with lower levels of IFN scores (p = 0.026). Conclusion: our result indicates that PAPS patients, without lupus specific antibodies, have an enhanced type I IFN gene signature, not observed in non-immune mediated thrombophilia. We also provide novel data demonstrating that this overexpression of type I IFN-regulated genes is associated with an earlier onset of APS events and preeclampsia. Further studies are necessary to determine if this subgroup of patients will benefit of interventions targeting the type I IFN signalling pathwa
Frequency and impact of obstructive sleep apnea in thrombotic primary antiphospholipid syndrome patients
No full textIntrodução: A apneia obstrutiva do sono (AOS) se associa com um aumento no risco de doenças cardiovasculares e cerebrovasculares. O entendimento do impacto da AOS nos pacientes com síndrome antifosfolípide primária trombótica (SAFPt) pode ser importante para se reduzir o risco de recorrência trombótica nesses pacientes. Objetivo: Avaliar a frequência de AOS nos pacientes com SAFPt, investigar a performance das ferramentas de rastreamento para AOS nesse cenário, e comparar o perfil clínico e laboratorial dos pacientes com SAFPt com e sem AOS. Métodos: Pacientes com SAFPt foram consecutivamente convidados para realizar estudos do sono utilizando monitores portáteis. AOS foi definida como um índice de apneiahipopneia 15 eventos/hora. A frequência de AOS nos pacientes com SAFPt foi comparada com controles derivados do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil), pareados por idade, sexo e índice de massa corpórea (IMC), na proporção de 1:3. A seguir, a performance de 3 ferramentas para rastreamento de AOS (questionário de Berlim, STOP-Bang e NoSAS) foi avaliada nos pacientes com SAFPt. Por fim, pacientes com SAFPt foram classificados de acordo com a presença de AOS, e suas características clínicas e laboratoriais (incluindo dano acumulado avaliado pelo Damage Index for Antiphospholipid Syndrome [DIAPS] e biomarcadores associados a trombose e ativação endotelial) foram comparadas utilizando procedimentos estatísticos usuais. Resultados: Cinquenta e dois pacientes foram incluídos na análise (sexo feminino: 82,7%, idade média 48±14 anos, IMC médio 31,1±6,5 kg/m2). Desses, 25% foram diagnosticados com AOS através do estudo do sono. Quando comparados com os controles pareados (N=115), não houve diferenças estatisticamente significativas na frequência da AOS nos pacientes com SAFPt (SAFPt: 12/42 [28,6%] vs. controles: 35/115 [30,4%], p=0,821). Entre as ferramentas de rastreamento, NoSAS apresentou a maior área sob a curva ROC (AUC 0,806, IC95% 0,672-0,939, p=0,001), seguida do STOP-Bang (AUC 0,772, IC95% 0,607-0,938, p=0,004); o questionário de Berlim não foi útil nesse contexto. Pacientes com SAFPt e AOS apresentaram maiores níveis de fator de von Willebrand (FvW) (mediana 38,9 vs. 32,6, p=0,038) e DIAPS (mediana 5 vs. 2, p=0,020) do que aqueles com SAFPt sem AOS. AOS se manteve estatisticamente associada ao maior DIAPS mesmo após controle para idade, duração de doença e IMC. Conclusão: AOS é comum nos pacientes com SAFPt, com frequência comparável a uma população não referenciada. Tanto o NoSAS quanto o STOP-Bang parecem ser úteis como ferramentas de rastreamento da AOS nos pacientes com SAFPt. Pacientes com SAFPt e AOS apresentaram um maior dano acumulado pela doença e maiores níveis de FvW, o que pode sugerir um fenótipo mais grave da SAFPt nesse contextoIntroduction: Obstructive sleep apnea (OSA) correlates with an increased risk of cardiovascular and cerebrovascular events. Understanding its impact in patients with thrombotic primary antiphospholipid syndrome (tPAPS) may contribute to mitigate thrombosis recurrence risk in these patients. Objective: We aimed to evaluate the frequency of OSA in patients with tPAPS, to investigate the performance of screening tools for OSA in this scenario and to compare clinical/laboratorial differences in tPAPS patients with and without OSA. Methods: We consecutively enrolled patients with tPAPS to undergo sleep studies using a portable monitor. OSA was defined as apneahypopnea index 15 events/hour. Frequency of OSA in tPAPS was evaluated and compared with age-, gender-, and BMI-matched controls (1:3 ratio) from the Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Next, we tested the performance of three different screening tools for assessing OSA in patients with tPAPS. Finally, patients with tPAPS were stratified according to OSA status comparing their clinical and laboratory characteristics (including damage burden measured by Damage Index for Antiphospholipid Syndrome [DIAPS] and biomarkers associated with thrombosis) using standard statistical procedures. Results: Fifty-two patients were included for analysis (females: 82.7%; mean age: 48±14 years; body-mass index: 31.1±6.5 kg/m2). Of those, 25% were diagnosed with OSA by sleep studies. When compared to matched controls from ELSA-Brasil (n=115), there were no significant differences in the frequencies of OSA (tPAPS: 12/42 [28.6%] vs. controls: 35/115 [30.4%], p=0.821). Among screening tools, NoSAS had the highest area under ROC curve (AUC 0.806, CI 95% 0.672-0.939, p=0.001), followed by STOP-Bang (AUC 0.772, CI 95% 0.607-0.938, p=0.004). Patients with comorbid tPAPS and OSA presented higher levels of von Willebrand factor (vWF) (median 38.9 vs. 32.6, p=0.038) and DIAPS (median 5 vs. 2, p=0.020), when compared to those without OSA. OSA remained statistically associated with higher DIAPS, even after controlling for age, disease duration and BMI. Conclusion: OSA is common in patients with tPAPS, with rates comparable to a nonreferred population. Both NoSAS and STOP-Bang scores seems to be useful for screening OSA in these patients. Patients with tPAPS+OSA had higher damage burden and higher levels of vWF, which might suggest a more severe phenotype of tPAPS in this scenari
Cognitive dysfunction (CD) and serum levels of brain-derived neurotrophic factor (BDNF) in primary antiphosholipid syndrome
No full textIntrodução: A disfunção cognitiva (DC) é uma manifestação não trombótica do sistema nervoso central, pouco compreendida na síndrome antifosfolípide (SAF). O fator neurotrófico derivado do cérebro (BDNF) é uma neurotrofina que desempenha um papel importante na plasticidade neural e pode potencialmente ser um biomarcador de DC na SAF primária. Objetivos: Avaliar a presença de DC em pacientes com SAF primária e sua associação com os dados clínicos, anticorpos antifosfolípides e níveis séricos de BDNF. Métodos: Este estudo transversal comparou 44 pacientes com SAF primária e 20 controles saudáveis pareados por idade, gênero e escolaridade. Os pacientes com SAF primária e controles foram submetidos a uma bateria de testes neuropsicológicos (NP) padronizada e adaptada para população estudada. Características demográficas, clínicas e laboratoriais dos pacientes com SAF primária foram analisadas buscando por associações com a presença de DC. O BDNF sérico foi avaliado pela técnica ELISA sanduíche. Resultados: Quatorze (31,8%) dos 44 pacientes com SAF primária tinham DC em comparação com apenas 1 (5%) controle (p = 0,019). Pacientes com SAF primária apresentaram níveis séricos de BDNF mais baixos quando comparados aos controles (647,3 ± 271,6 vs. 863,0 ± 318,6 ng/mL; p = 0,007). A DC em pacientes com SAF primária foi associada a níveis significantemente mais baixos de BDNF sérico (p = 0,032). Na análise univariada, foi encontrada uma associação positiva entre DC e livedo reticular, trombose venosa profunda, acidente vascular cerebral (AVC), convulsão, tabagismo, bem como uma associação negativa com o Mini- Exame do Estado Mental e o BDNF sérico. De acordo com a análise multivariada, o único preditor independente de DC na SAF primária foi o AVC (OR 137,06; IC 95%, 4,73-3974,32; p = 0,004). Conclusão: A DC é comumente descrita em pacientes com SAF primária; no entanto, sua avaliação carece de testes de triagem objetivos e padronizados. Nosso estudo demonstrou que a DC pode ser identificada na SAF primária, aplicando-se uma bateria de testes NP padronizada e adaptada à população brasileira, e a associação entre DC e BDNF sérico sugere essa neurotrofina como biomarcador promissor no diagnóstico de comprometimento cognitivo na SAF primáriaIntroduction: Cognitive dysfunction (CD) is a poorly understood non-stroke central neurological manifestation in antiphospholipid syndrome (APS). Brain-derived neurotrophic factor (BDNF) is a neurotrophin that plays an important role in the neural plasticity, and could potentially be a biomarker of CD in primary APS (PAPS). Objectives: The aim of the study is to assess CD in PAPS patients and to evaluate its association with clinical data, antiphospholipid antibodies and serum BDNF levels. Methods: This crosssectional study compared 44 PAPS patients and 20 healthy controls matched for age, gender and education. PAPS patients and controls underwent an adapted standardized cognitive examination to the studied population. The demographic, clinical, and laboratory characteristics of patients were analysed searching for associations with CD presence. Serum BDNF was measured by sandwich ELISA. Results: Fourteen (31.8%) of the 44 patients with PAPS had CD compared with only 1 (5%) healthy control (p=0.019). PAPS patients presented lower serum BDNF levels when compared with controls (647.3 ± 271.6 vs. 863.0 ± 318.6 ng/mL, p=0.007). Lower levels of BDNF were associated with CD in PAPS patients (p=0.032). In the univariate analysis, a positive association was found between CD and livedo reticularis, deep vein thrombosis, stroke, seizure, smoking as well as a negative association with Mini Mental State Examination and serum BDNF. According to multivariate analysis, the only independent predictor of CD in PAPS was stroke (OR 137.06; 95%CI, 4.73-3974.32; p=0.004). Conclusion: CD is commonly reported in PAPS patients; however, its assessment lacks in standards and objective screening tests. Our study demonstrated that CD can be detected in PAPS by applying a standardized NP test battery adapted to the Brazilian population, and the association between CD and serum BDNF levels suggests that this neurotrophin can be a promising biomarker in the diagnosis of PAPS cognitive impairmen
- …
