JEFFERSON ROSI JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
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- Cavernous carotid artery aneurysms: Epidemiology, natural history, diagnostic and treatment. An experience of a single institution(2014) ROSI JUNIOR, Jefferson; WELLING, Leonardo C.; YENG, Lin Tchia; CALDAS, Jose Guilherme; SCHAFRANSKI, Marcelo; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBackground: Cavernous carotid aneurysms (CCA) account for 2-9% of all intracranial aneurysms. They have been considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. These aneurysms are unique, their rupture can present in many different forms, they can suffer spontaneous thrombotic changes and the symptomatology related to the mass effect involves the neuro-ophthalmologic system. In this scenario the natural history and clinical presentation are largely different from other intracranial aneurysms. Some investigators advocate treatment of both symptomatic and asymptomatic CCAs, others recommend no treatment. The reason for this controversy relates to a lack of information on the long term natural history of these aneurysms, as well as on the long term results of treatment. Methods: In this article the authors discuss their single institution experience in diagnosis, natural history and management of 123 asymptomatic and oligosympotomatic aneurysms located in the cavernous portion of internal carotid artery. Conclusions: According to our results asymptomatic or olygosymptomatic (pain) CCAs should be conservatively managed with serial images while the others presentations should be analyzed by a multidisciplinary team, involving the neuroendovascular and microsurgical services.
bookPart Medicina Fisica e Reabilitação em Doentes com Dor Crônica(2019) YENG, Lin Tchia; PAI, Marcus Yu Bin; KOBAYASHI, Ricardo; TEIXEIRA, Manoel Jacobsen; JR, Jefferson Rosi- Corticomotor excitability is altered in central neuropathic pain compared with non-neuropathic pain or pain-free patients(2023) BARBOSA, Luciana Mendonca; VALERIO, Fernanda; SILVA, Valquiria Aparecida da; RODRIGUES, Antonia Lilian de Lima; GALHARDONI, Ricardo; YENG, Lin Tchia; JUNIR, Jefferson Rosi; CONFORTO, Adriana Bastos; LUCATO, Leandro Tavares; TEIXEIRA, Manoel Jacobsen; ANDRADE, Daniel Ciampi deObjectives: Central neuropathic pain (CNP) is associated with altered corticomotor excitability (CE), which can potentially provide insights into its mechanisms. The objective of this study is to describe the CE changes that are specifically related to CNP.Methods: We evaluated CNP associated with brain injury after stroke or spinal cord injury (SCI) due to neuromyelitis optica through a battery of CE measurements and comprehensive pain, neurological, functional, and quality of life assessments. CNP was compared to two groups of patients with the same disease: i. with non-neuropathic pain and ii. without chronic pain, matched by sex and lesion location.Results: We included 163 patients (stroke=93; SCI=70: 74 had CNP, 43 had non-neuropathic pain, and 46 were pain-free). Stroke patients with CNP had lower motor evoked potential (MEP) in both affected and unaffected hemispheres compared to non-neuropathic pain and no-pain patients. Patients with CNP had lower amplitudes of MEPs (366 mu V +/- 464 mu V) than non-neuro-pathic (478 +/- 489) and no-pain (765 mu V +/- 880 mu V) patients, p < 0.001. Short-interval intracorti-cal inhibition (SICI) was defective (less inhibited) in patients with CNP (2.6 +/- 11.6) compared to no-pain (0.80.7), p = 0.021. MEPs negatively correlated with mechanical and cold-induced allo-dynia. Furthermore, classifying patients' results according to normative data revealed that at least 75% of patients had abnormalities in some CE parameters and confirmed MEP findings based on group analyses.Discussion: CNP is associated with decreased MEPs and SICI compared to non-neuropathic pain and no-pain patients. Corticomotor excitability changes may be helpful as neurophysiological markers of the development and persistence of pain after CNS injury, as they are likely to pro-vide insights into global CE plasticity changes occurring after CNS lesions associated with CNP.(c) 2023 The Author(s).
- A Bibliometric Analysis of the Most Cited Articles in Neurocritical Care Research(2019) RAMOS, Miguel Bertelli; KOTERBA, Edwin; ROSI JUNIOR, Jefferson; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBibliometric analyses may indicate the most active journals, authors, countries, institutions and specialties by evaluating the most cited articles in a given research field. To the authors' knowledge, there is no bibliometric analysis regarding neurocritical care research. Thus, the aim of this study is to analyze and to provide a scope of the current scientific production in this area. The 100 most cited articles in the neurocritical care research were retrieved from the research ""(neurocritical) AND (care)"" in the Scopus database. The variables collected and included in this analysis were: number of citations, article title, first author's name, year and journal of publication and its impact factor (IF), specialty, affiliation and country of the corresponding author at the time of publication, and category of the article. Also, these variables were assessed for primary research only. The articles were published in 34 different journals from 1995 to 2017, with a mean citation number of 109.36, ranging from 44 to 540. Neurocritical Care (23 articles in top 100 and 2190 citations, IF = 3.163) and Critical Care Medicine (20 articles and 2896 citations in top 100, IF = 6.630) were the journals with the greatest number of articles and citations, respectively. Neurocritical Care also had the highest number of primary research papers (15 articles, accounting for 850 citations). Excepting one article from Asia (Singapore) and one from Oceania (Australia), all the other 98 papers were from North America (67) or Europe (31). United States was the country with most articles (60, 35 primary research) and citations (6115) among the top 100. Columbia University (11 articles, being 7 primary research, and 915 citations) was the institution with the highest number of articles and primary research articles in top 100, whereas University of Heidelberg (6 articles and 1220 citations) was the most cited institution. Neurology was the specialty with the greatest number of publications in top 100 and the most cited one (57 articles and 5983 citations). The first author with the greatest number of publications as well as primary research articles was A. I. Qureshi (5 articles, being 4 primary research, and 660 citations), while the most cited was K. H. Polderman (2 articles and 749 citations). Fifty-nine publications were primary and 41 secondary research. Among primary research, treatment/management was the most frequent and most cited topics (33 articles and 4172 citations). To the authors' knowledge, this is the first bibliometric analysis regarding neurocritical care research. Our findings suggest that the neurocritical care research field is more prominent in North America and Europe, more frequently published in specific critical care journals and after 1994. The most discussed topic was related to treatment and/or management within neurocritical care.
- Homocysteine serum levels in patients with ruptured and unruptured intracranial aneurysms: a case-control study(2024) TELLES, Joao Paulo Mota; ROSI JUNIOR, Jefferson; YAMAKI, Vitor Nagai; RABELO, Nicollas Nunes; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBackground There is very few data regarding homocysteine's influence on the formation and rupture of intracranial aneurysms. Objective To compare homocysteine levels between patients with ruptured and unruptured intracranial aneurysms, and to evaluate possible influences of this molecule on vasospasm and functional outcomes. Methods This is a retrospective, case-control study. We evaluated homocysteinemia differences between patients with ruptured and unruptured aneurysms; and the association of homocysteine levels with vasospasm and functional outcomes. Logistic regressions were performed. Results A total of 348 participants were included: 114 (32.8%) with previous aneurysm rupture and 234 (67.2%) with unruptured aneurysms. Median homocysteine was 10.75 mu mol/L (IQR = 4.59) in patients with ruptured aneurysms and 11.5 mu mol/L (IQR = 5.84) in patients with unruptured aneurysms. No significant association was detected between homocysteine levels and rupture status (OR = 0.99, 95% CI = 0.96-1.04). Neither mild (>15 mu mol/L; OR = 1.25, 95% CI 0.32-4.12) nor moderate (>30 mu mol/L; OR = 1.0, 95% CI = 0.54-1.81) hyperhomocysteinemia demonstrated significant correlations with ruptured aneurysms. Neither univariate (OR = 0.86; 95% CI 0.71-1.0) nor multivariable age-adjusted (OR = 0.91; 95% CI = 0.75-1.05) models evidenced an association between homocysteine levels and vasospasm. Homocysteinemia did not influence excellent functional outcomes at 6 months (mRS <= 1) (OR = 1.04; 95% CI = 0.94-1.16). Conclusion There were no differences regarding homocysteinemia between patients with ruptured and unruptured intracranial aneurysms. In patients with ruptured aneurysms, homocysteinemia was not associated with vasospasm or functional outcomes.
- Concomitant craniospinal injuries and whole-body CT Comments(2012) JUNIOR, Jefferson R.; FIGUEIREDO, Eberval G.; TEIXEIRA, Manoel J.
- Insular and anterior cingulate cortex deep stimulation for central neuropathic pain Disassembling the percept of pain(2019) GALHARDONI, Ricardo Geront; SILVA, Valquiria Aparecida da; GARCIA-LARREA, Luis; DALE, Camila; BAPTISTA, Abrahao F.; BARBOSA, Luciana Mendonca; MENEZES, Luciana Mendes Bahia; SIQUEIRA, Silvia R. D. T. de; VALERIO, Fernanda; ROSI JR., Jefferson; RODRIGUES, Antonia Lilian de Lima; FERNANDES, Diego Toledo Reis Mendes; SELINGARDI, Priscila Mara Lorencini; MARCOLIN, Marco Antonio; DURAN, Fabio Luis de Souza; ONO, Carla Rachel; LUCATO, Leandro Tavares; FERNANDES, Ana Mercia B. L.; SILVA, Fabio E. F. da; YENG, Lin T.; BRUNONI, Andre R.; BUCHPIGUEL, Carlos A.; TEIXEIRA, Manoel J.; ANDRADE, Daniel Ciampi deObjective To compare the analgesic effects of stimulation of the anterior cingulate cortex (ACC) or the posterior superior insula (PSI) against sham deep (d) repetitive (r) transcranial magnetic stimulation (TMS) in patients with central neuropathic pain (CNP) after stroke or spinal cord injury in a randomized, double-blinded, sham-controlled, 3-arm parallel study. Methods Participants were randomly allocated into the active PSI-rTMS, ACC-rTMS, sham-PSI-rTMS, or sham-ACC-rTMS arms. Stimulations were performed for 12 weeks, and a comprehensive clinical and pain assessment, psychophysics, and cortical excitability measurements were performed at baseline and during treatment. The main outcome of the study was pain intensity (numeric rating scale [NRS]) after the last stimulation session. Results Ninety-eight patients (age 55.02 +/- 12.13 years) completed the study. NRS score was not significantly different between groups at the end of the study. Active rTMS treatments had no significant effects on pain interference with daily activities, pain dimensions, neuropathic pain symptoms, mood, medication use, cortical excitability measurements, or quality of life. Heat pain threshold was significantly increased after treatment in the PSI-dTMS group from baseline (1.58, 95% confidence interval [CI] 0.09-3.06]) compared to sham-dTMS (-1.02, 95% CI -2.10 to 0.04, p = 0.014), and ACC-dTMS caused a significant decrease in anxiety scores (-2.96, 95% CI -4.1 to -1.7]) compared to sham-dTMS (-0.78, 95% CI -1.9 to 0.3; p = 0.018). Conclusions ACC- and PSI-dTMS were not different from sham-dTMS for pain relief in CNP despite a significant antinociceptive effect after insular stimulation and anxiolytic effects of ACC-dTMS. These results showed that the different dimensions of pain can be modulated in humans noninvasively by directly stimulating deeper SNC cortical structures without necessarily affecting clinical pain per se.
- Into the Island: A new technique of non-invasive cortical stimulation of the insula(2012) ANDRADE, D. Ciampi de; GALHARDONI, R.; PINTO, L. F.; LANCELOTTI, R.; ROSI JR., J.; MARCOLIN, M. A.; TEIXEIRA, M. J.Study aim. - We describe a new neuronavigation-guided technique to target the posterior-superior insula (PSI) using a cooled-double-cone coil for deep cortical stimulation. Introduction. - Despite the analgesic effects brought about by repetitive transcranial magnetic stimulation (TMS) to the primary motor and prefrontal cortices, a significant proportion of patients remain symptomatic. This encouraged the search for new targets that may provide stronger pain relief. There is growing evidence that the posterior insula is implicated in the integration of painful stimuli in different pain syndromes and in homeostatic thermal integration. Methods. - The primary motor cortex representation of the lower leg was used to calculate the motor threshold and thus, estimate the intensity of PSI stimulation. Results. - Seven healthy volunteers were stimulated at 10 Hz to the right PSI and showed subjective changes in cold perception. The technique was safe and well tolerated. Conclusions. - The right posterior-superior insula is worth being considered in future studies as a possible target for rTMS stimulation in chronic pain patients.
bookPart Dor e Sono(2019) TEIXEIRA, Manoel Jacobsen; YENG, Lin Tchia; ROSI JR., Jefferson; YOSHINAGA, Nancy- Posterior-superior insular deep transcranial magnetic stimulation alleviates peripheral neuropathic pain - A pilot double-blind, randomized cross-over study(2021) DONGYANG, Liu; FERNANDES, Ana Mercia; CUNHA, Pedro Henrique Martins da; TIBES, Raissa; SATO, Joao; LISTIK, Clarice; DALE, Camila; KUBOTA, Gabriel Taricani; GALHARDONI, Ricardo; TEIXEIRA, Manoel Jacobsen; SILVA, Valquiria Aparecida da; ROSI, Jefferson; ANDRADE, Daniel Ciampi deObjectives. - Peripheral neuropathic pain (pNeP) is prevalent, and current treatments, including drugs and motor cortex repetitive transcranial magnetic stimulation (rTMS) leave a substantial proportion of patients with suboptimal pain relief. Methods. - We explored the intensity and short-term duration of the analgesic effects produced in pNeP patients by 5 days of neuronavigated deep rTMS targeting the posterior superior insula (PSI) with a double-cone coil in a sham-controlled randomized cross-over trial. Results. - Thirty-one pNeP patients received induction series of five active or sham consecutive sessions of daily deep-rTMS to the PSI in a randomized sequence, with a washout period of at least 21 days between series. The primary outcome [number of responders (>50% pain intensity reduction from baseline in a numerical rating scale ranging from 0 to 10)] was significantly higher after real (58.1%) compared to sham (19.4%) stimulation (p = 0.002). The number needed to treat was 2.6, and the effect size was 0.97 [95% CI (0.6; 1.3)]. One week after the 5th stimulation day, pain scores were no longer different between groups, and no difference in neuropathic pain characteristics and interference with daily living were present. No major side effects occurred, and milder adverse events (i.e., short-lived headaches after stimulation) were reported in both groups. Blinding was effective, and analgesic effects were not affected by sequence of the stimulation series (active-first or sham-first), age, sex or pain duration of participants. Discussion. - PSI deep-rTMS was safe in refractory pNeP and was able to provide significant pain intensity reduction after a five-day induction series of treatments. Post-hoc assessment of neuronavigation targeting confirmed deep-rTMS was delivered within the boundaries of the PSI in all participants. Conclusion. - PSI deep-rTMS provided significant pain relief during 5-day induction sessions compared to sham stimulation.