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Orientador: Prof. Dr. André Martins Vaz dos Santos Coorientador: Prof. Dr. José Ricardo de Souza Barradas Dissertação (mestrado) - Universidade Federal do Paraná, Setor de Palotina, Programa de Pós-Graduação em Aquicultura e Desenvolvimento Sustentável. Defesa : Palotina, 14/12/2018 Inclui referências: p.30-31 Resumo: Phalloceros harpagos é uma espécie de pequeno porte com ampla ocorrência natural em bacias hidrográficas da região Sudeste-Sul do Brasil. A espécie apresenta grande resistência em hábitats impactados, caracterizando-a como potencial bioindicador de qualidade ambiental. O rio Verde (bacia do rio Tibagi, Paraná) é impactado por ações antrópicas. Este trabalho analisou duas populações de P. harpagos quanto a aspectos de crescimento em quatro pontos do rio Verde: 1-Parque Nacional dos Campos Gerais; 2-Cemitério Campos Gerais; 3-Passadouro; 4- Sanepar, onde foram realizadas coletas mensais durante o período de junho de 2016 a maio de 2017. Foram coletados dados de comprimento total (Lt, cm) e peso total (Wt, g). O sexo foi identificado macroscopicamente através da presença de gonopódio nos machos. O objetivo deste trabalho foi identificar padrões de crescimento polifásico para o P. harpagos através de dados de comprimento e peso. Buscou-se também o entendimento de relações entre crescimento e atingimento da maturidade sexual. Dois modelos foram utilizados e comparados através de um algoritmo automatizado para descrever o crescimento, um deles considerando crescimento constante ao longo do ciclo de vida e outro capaz de identificar mudanças no padrão de crescimento. Os dados foram analisados para a população do Ponto 1 e para a população dos Pontos 2, 3 e 4, e em todos os modelos foi possível identificar alterações no padrão de crescimento, com o segundo modelo quase sempre obtendo melhores resultados tanto no ajuste da curva quanto comparativamente ao modelo mais simples. Em geral para quase todas as análises, o modelo polifásico apresentou um melhor resultado matemático, mas isso não implicou necessariamente em um resultado biologicamente representativo. O modelo polifásico corroborou com uma análise de maior sensibilidade para P. harpagos, uma espécie que apresenta limitações sobre o estudo de seu crescimento, considerando a falta de estudos que empreguem o uso do modelo polifásico. Palavras-chave: relação peso-comprimento; modelo de Huxley; modelo polifásico. Abstract: Phalloceros harpagos is a small species with large natural occurrence in watersheds in the Southeast-South region of Brazil. The species presents great resistance in impacted habitats, characterizing it as a potential bioindicator of environmental quality. The Green river (basin of the Tibagi River, Paraná) is impacted by anthropic actions. This work analyzed populations of P. harpagos in relation to aspects of growth in four points of the Verde River: 1 - Campos Gerais National Park; 2-Campos Gerais Cemetery's; 3-Passadouro; 4-Sanepar, where monthly data were collected during the period from June 2016 to May 2017. Data of total length (Lt, cm) and total weight (Wt, g) were collected. Sex was I dentified macroscopically through the presence of gonopodia in males. The aim of this work was to identify polyphasic growth patterns for P. harpagos through length and weight data. It was also sought the understanding of the relationships between growth and attainment of sexual maturity. Two models were used and compared through an automated algorithm to describe the growth, one considering constant growth throughout the life cycle and the other capable of identifying changes in growth pattern. The data were analyzed for the population of Point 1 and for the population of Points 2, 3 and 4, and in all available model options. Compared to the simplest model. Emission to almost all analytics, the polyphonic model is in the objective of the most important mathematical result, but this does not imply for biologically representative. The polyphasic model corroborated with a more sensitive analysis for the case studies, in view of the presentation of studies on the growth of the polyphasic model. Keywords: Weight?to?Length Relationship; Huxley's model; polyphasic model

The aim of the present study was to investigate the efficacy of infliximab for the treatment of extrapulmonary sarcoidosis. A prospective, randomised, double-blind, placebo-controlled trial was conducted, with infliximab at 3 and 5 mg x kg(-1) body weight administered over 24 weeks. Extrapulmonary organ severity was determined by a novel severity tool (extrapulmonary physician organ severity tool; ePOST) with an adjustment for the number of organs involved (ePOSTadj). In total, 138 patients enrolled in the trial of infliximab versus placebo for the treatment of chronic corticosteroid-dependent pulmonary sarcoidosis. The baseline severity of extrapulmonary organ involvement, as measured by ePOST, was similar across treatment groups. After 24 weeks of drug-therapy study, the change from baseline to week 24 in ePOST was greater for the combined infliximab group compared with the placebo group. After adjustment for the number of extrapulmonary organs involved, the improvement in ePOSTadj observed in the combined infliximab group was also greater than that observed in placebo-treated patients, after 24 weeks of therapy. The improvements in ePOST and ePOSTadj were not maintained during a subsequent 24-week washout period. Infliximab may be beneficial compared with placebo in the treatment of extrapulmonary sarcoidosis in patients already receiving corticosteroids, as assessed by the severity tool described in the present study.

Sarcoidosis is a multiorgan disease with no single etiology. Evidence over the years points to complex interactions between environmental and genetic factors and a hypersensitive immune response to these insults. This brief overview discusses the uncertainty in the diagnosis of sarcoidosis versus other granulomatous diseases masquerading as sarcoidosis. The diagnostic dilemma is highlighted by a brief case review. The development of newer techniques in molecular biology and the identification of a panel of biomarkers in the future with appreciable specificity and sensitivity would help in the process. Future studies to determine receiver operating curves (ROC) using multiple biomarker combinations would help develop robust testing. More in-depth studies are also needed for defining the immunological basis of sarcoidosis because recent studies implicate Th17 cells in addition to the Th1 cell pathway. It is very likely that direct exposure to environmental agents and systemic distribution of these agents can elicit an exaggerated immune response leading to multiorgan granuloma formation mimicking sarcoidosis. A genetically susceptible host may be necessary to complete the granulomatous response to the particulate matter.

Study objective To determine the demographic, clinical, and radiographic characteristics of corticosteroid-treated patients with sarcoidosis who developed relapse following a period of clinical stability lasting longer than 1 month, and to compare these characteristics with those of a group of patients with sarcoidosis who were not treated. Design Historic, concurrent and prospective, nonrandomized, observational study. Setting Ambulatory sarcoidosis clinic in a university city hospital. Patients Over a 4-year calendar period, 337 patients with sarcoidosis were prospectively enrolled in a registry. One hundred eighteen patients were assigned to a spontaneous remission group when symptoms resolved without treatment, and 103 were assigned to an induced remission group when symptoms resolved following corticosteroid therapy and successful discontinuation. In 116 patients assigned to a recalcitrant group, therapy could not be stopped for 1 month or more owing to severity of symptoms or lack of compliance. We defined relapse as a recurrence of symptoms of sufficient severity to warrant treatment with corticosteroids, following a remission without treatment lasting greater than 1 month. Intervention Patients who were judged to be sufficiently symptomatic to preclude observation without treatment or who failed to respond to conservative treatment with topical or inhaled corticosteroids or nonsteroidal anti-inflammatory agents were treated with systemic corticosteroids at a target dose of 20 mg prednisone per day for 1 year. Measurements and results We observed a 74% relapse rate in the induced remission group, but only an 8% relapse rate in the spontaneous remission group (p Conclusions Relapse occurred frequently in patients with sarcoidosis who had been treated with corticosteroids, and rarely occurred in patients who had not been treated with corticosteroids in the past. The striking difference in relapse rate between treated and untreated patients suggests that patients with disease that would later be severe and protracted were almost unerringly identified early in their course. One explanation is that severe presenting symptoms portend a protracted and recurrent course; an alternative explanation is that corticosteroids contributed to the prolongation of the disease by delaying resolution.

We describe the case of a 57-year-old man with severe refractory hypoxemia, despite receiving ventilation therapy with 100% oxygen, following a gunshot wound to his left chest. A limited CT scan of the chest with contrast raised the suspicion of an arteriovenous (AV) fistula. Contrast-enhanced transthoracic echocardiography confirmed the presence of a pulmonary AV fistula. Traumatic pulmonary AV fistula is a rare, but serious and life-threatening condition that should be suspected in patients with thoracic injuries with persistent unexplained hypoxemia. Contrast echocardiography is a relatively simple, inexpensive, and readily available bedside test that can be used to confirm this diagnosis.

To redefine the utility of CSF-ACE as a selective indicator of probable CNS neurosarcoidosis.The diagnosis of probable CNS neurosarcoidosis required: (a) biopsy evidence of systemic sarcoidosis, (b) cortical, brainstem, and/or spinal cord deficits, (c) enhancing lesions on brain and/or spinal cord MRI, and (d) exclusion of other etiologies which could account for the neurological deficits. Radioassay measurement of CSF-ACE activity was performed in 11 patients who met our criteria for probable CNS neurosarcoidosis and 207 control patients.The M +/- SD for CSF-ACE activity was significantly higher (p0.05) for the 11 probable CNS neurosarcoidosis patients (9.5 +/- 6.9 nmol/mL/min) than for the control patients (2.9 +/- 2.7 nmol/mL/min). The optimal CSF-ACE activity discriminator value was 8 nmol/mL/min. At this value, the sensitivity and specificity of CSF-ACE activity was 55% and 94%, respectively.CSF-ACE activity is a useful biochemical marker of probable CNS neurosarcoidosis when brain and/or spinal cord MRI show diffuse enhancing lesions.

We examined the clinical characteristics of six patients with myelofibrosis secondary to myeloproliferative diseases whose clinical courses were complicated by pulmonary hypertension to determine possible causal links between the two disorders. Six patients (four male, two female), with diagnoses of myeloproliferative disease, myelofibrosis (one with polycythemia vera, three with agnogenic myeloid metaplasia, one with unclassified myeloproliferative syndrome, one with essential thrombocytosis), and pulmonary hypertension are presented. Measurement of the pulmonary artery pressure was performed by Doppler echocardiography in all patients and by right sided heart catheterization in four patients. The range of resting pulmonary artery systolic pressure was 35 to 47 mmHg above the mean right atrium by echocardiography. One patient had autopsy evidence of pulmonary myeloid metaplasia and interstitial fibrosis; another had acute leukemic infiltration of the lung parenchyma. All patients had thrombocytosis; symptomatology in one patient with marked thrombocytosis improved with plateletpheresis. Two patients suffered systemic thrombosis. All patients had severe hepatomegaly. Two patients had evidence of left ventricular dysfunction. The interval between the development of dyspnea and death was less than seven months in five of the patients. A causal link between pulmonary hypertension and myelofibrosis secondary to myeloproliferative diseases is suggested for each patient. Hematopoietic infiltration of the pulmonary parenchyma, portal hypertension, thrombocytosis, hypercoagulability, and left ventricular failure may account in part for the development of pulmonary hypertension in these patients. Patients with myelofibrosis and dyspnea should have Doppler echocardiography to evaluate pulmonary artery pressures.

Chronic cough is a common symptom presenting to all clinicians. Every effort should be made to determine the cause(s) of cough because specific therapy has a higher likelihood of success than empiric therapy. Evaluation begins with a complete history, physical examination, routine health screen laboratory testing, chest film, and pulmonary function testing. Further investigation should be guided by the response to treatment of the most likely diagnostic possibilities: postnasal drip, cough-variant asthma, gastroesophageal reflux, chronic bronchitis, bronchiectasis, and ACE inhibitor induced. The majority of each patient's workup can be performed and ordered by the primary care physician.

Objectives Immunosuppressive pharmacologic agents prescribed to patients with diffuse interstitial and inflammatory lung disease and lung transplant recipients are associated with potential risks for adverse reactions. Strategies for minimizing such risks include administering these drugs according to established, safe protocols; monitoring to detect manifestations of toxicity; and patient education. Hence, an evidence-based guideline for physicians can improve safety and optimize the likelihood of a successful outcome. To maximize the likelihood that these agents will be used safely, the American College of Chest Physicians established a committee to examine the clinical evidence for the administration and monitoring of immunosuppressive drugs (with the exception of corticosteroids) to identify associated toxicities associated with each drug and appropriate protocols for monitoring these agents. Methods Committee members developed and refined a series of questions about toxicities of immunosuppressives and current approaches to administration and monitoring. A systematic review was carried out by the American College of Chest Physicians. Committee members were supplied with this information and created this evidence-based guideline. Conclusions It is hoped that these guidelines will improve patient safety when immunosuppressive drugs are given to lung transplant recipients and to patients with diffuse interstitial lung disease.

Early studies of 67gallium (67Ga) scanning in sarcoidosis focused on the lungs as a measure of disease activity, likelihood of progression, and the advisability of corticosteroid therapy. The predictive value of pulmonary uptake proved to be limited, but there has been renewed interest in 67Ga scanning as a diagnostic aid with special attention to characteristic extrapulmonary uptake patterns. Review of whole-body 67Ga scans in 172 patients with sarcoidosis, 21 with lymphoma, and 51 with other disorders demonstrated distinctive cranial, mediastinal, and hilar uptake patterns in sarcoidosis patients. Bilateral hilar uptake occurred in 81 sarcoidosis patients (47%) but in no lymphoma cases. Increased lacrimal and/or salivary gland uptake was observed in 47.5% but lacked specificity. Uptake in peripheral lymph nodes was infrequent in sarcoidosis (5%) but common in lymphoma (57%). 67Ga scans are especially valuable in patients with uveitis and liver granulomas whose chest radiographs are normal or equivocal. 67Ga scans, unnecessary in typical cases of sarcoidosis, have an important diagnostic role by reducing the need for invasive biopsy procedures in asymptomatic patients.

Formaldehyde (HCHO) has been reported to impair mucociliary clearance. The present investigation using rabbit and porcine tracheal explants in vitro examined (1) the impairment of ciliary activity, an essential component of mucociliary clearance; (2) the reversibility of ciliary dysfunction after HCHO exposure; and (3) the mechanism by which ciliary activity is reduced by HCHO. HCHO treatment of rabbit tracheal rings significantly decreased zones of active ciliated epithelium in direct proportion to concentration and exposure duration. There was also a significant concentration-dependent reduction of ciliary beat frequency. Removal of HCHO permitted recovery of zones of ciliary activity to normal beat frequencies; greater inhibitory concentrations of HCHO required greater time for return of function. Treatment of porcine tracheae with increasing concentrations of HCHO for time periods inhibitory to rabbit ciliary activity correspondingly reduced the yield of cilia extractable from treated epithelium. Furthermore, the specific activity of ATPase of extracted ciliary axonemes was diminished with increasing HCHO concentration, indicating loss of function. A recovery period following identical exposures of the porcine tracheae to the lower HCHO concentrations resulted in normal yields of functionally intact ciliary axonemes. Similarly, a recovery period after the highest HCHO concentration produced more functional axonemes than obtained from exposed tracheae without a recovery period, although less than normal yields. Therefore, ciliary dysfunction elicited by a defined range of HCHO concentrations is reversible. The yield and functional integrity of ciliary axonemes from epithelium exposed to HCHO with a recovery period are significantly greater than those without such a recovery period, suggesting an alteration and subsequent repair of epithelial surface components following HCHO exposure.