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
18 resultados
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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).
- 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.
bookPart Dor e Sono(2019) TEIXEIRA, Manoel Jacobsen; YENG, Lin Tchia; ROSI JR., Jefferson; YOSHINAGA, Nancy- Author response: Insular and anterior cingulate cortex deep stimulation for central neuropathic pain: Disassembling the percept of pain(2020) ANDRADE, Daniel Ciampi de; GALHARDONI, Ricardo; 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, 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.
- Motor corticospinal excitability abnormalities differ between distinct chronic low back pain syndromes(2023) SILVA, Marcelo Luiz da; FERNANDES, Ana Mercia; SILVA, Valquiria A.; GALHARDONI, Ricardo; FELAU, Valter; ARAUJO, Joaci O. de; JR, Jefferson Rosi; BROCK, Roger S.; KUBOTA, Gabriel T.; TEIXEIRA, Manoel J.; YENG, Lin T.; ANDRADE, Daniel Ciampi deObjectives: It is not known whether cortical plastic changes reported in low-back pain (LBP) are present in all etiologies of LBP. Here we report on the assessment of patients with three LBP con-ditions: non-specific-LBP (ns-LBP), failed back surgery syndrome (FBSS), and sciatica (Sc).Methods: Patients underwent a standardized assessment of clinical pain, conditioned pain mod-ulation (CPM), and measures of motor evoked potential (MEPs)-based motor corticospinal excit-ability (CE) by transcranial magnetic stimulation, including short interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Comparisons were also made with normative data from sex-and age-matched healthy volunteers.Results: 60 patients (42 women, 55.1 +/- 9.1 years old) with LBP were included (20 in each group). Pain intensity was higher in patients with neuropathic pain [FBSS (6.8 +/- 1.3), and Sc (6.4 +/- 1.4)] than in those with ns-LBP (4.7 +/- 1.0, P<0.001). The same was shown for pain interference (5.9 +/- 2.0, 5.9 +/- 1.8, 3.2 +/- 1.9, P<0.001), disability (16.4 +/- 3.3, 16.3 +/- 4.3, 10.4 +/- 4.3, P<0.001), and catastrophism (31.1 +/- 12.3, 33.0 +/- 10.4, 17.4 +/- 10.7, P<0.001) scores for FBSS, Sc, and ns-LBP groups, respectively. Patients with neuropathic pain (FBSS, Sc) had lower CPM (-14.8 +/- 1.9,-14.1 +/- 16.7, respectively) compared to ns-LBP (-25.4 +/- 16.6; P<0.02). 80.0% of the FBSS group had defective ICF compared to the other two groups (52.5% for ns-LBP, P=0.025 and 52.5% for Sc, P=0.046). MEPs (140%-rest motor threshold) were low in 50.0% of patients in the FBSS group com-pared to 20.0% of ns-LBP (P=0.018) and 15.0% of Sc (P=0.001) groups. Higher MEPs were corre-lated with mood scores (r=0.489), and with lower neuropathic pain symptom scores(r=-0.415) in FBSS.Conclusions: Different types of LBP were associated with different clinical, CPM and CE profiles, which were not uniquely related to the presence of neuropathic pain. These results highlight the need to further characterize patients with LBP in psychophysics and cortical neurophysiology studies.(c) 2023 The Author(s).
- Long-term deep-TMS does not negatively affect cognitive functions in stroke and spinal cord injury patients with central neuropathic pain(2019) SELINGARDI, Priscila Mara Lorencini; RODRIGUES, Antonia Lilian de Lima; SILVA, Valquiria Aparecida da; FERNANDES, Diego Toledo Reis Mendes; ROSI JR., Jefferson; MARCOLIN, Marco Antonio; YENG, Lin T.; BRUNONI, Andre R.; TEIXEIRA, Manoel J.; GALHARDONI, Ricardo; ANDRADE, Daniel Ciampi de
- Epidural Hematoma: A Prospective Analysis of Morbidity and Mortality in 173 Patients(2015) ROSI JUNIOR, Jefferson; ANDRADE, Almir Ferreira; YENG, Lint Chia; KOTERBA, Edwin; FIGUEIREDO, Eberval Gadelha de; LEPSKI, Guilherme; TEIXEIRA, Manoel JacobsenObjectives A few recent studies have focused on epidural hematomas (EDHs) that are routine in emergency rooms. The study was to evaluate the latest situation of affected patients by encephalic trauma associated with EDH in our service. Methods Prospective study between September 1, 2003 and May 30, 2009. Data were computed regarding age, sex, traumamechanism, qualification by Glasgow coma scale admission, presence of anisocoria, and evaluation by the recovery of Glasgow scale high, with all patients by computed tomography (CT) scan. Results Among the 173 analyzed patients, mortality reached 20 patients (11.5%). Mortality was higher in the subgroup of 76 patients (44%) admitted with Glasgow coma scale (GCS <= 8) with 17 deceased, corresponding to 85% of total deaths. Prevalence of male subjects (140 cases, 81%) with bruises located in the temporal, frontal and parietal regions; 147 (85%) patients underwent neurosurgical treatment by craniotomy. The worst prognosis was in patients with hematomas of higher-volume (50 mL), midline structures deviations greater than 1.5 mm and basal cisterns CSF closed. Conclusion The authors emphasize the correct indication of neurosurgery and the postoperative intensive care unit (ICU) as key factors for success in the treatment of patients with EDHs.
- Prognostic model for patients with traumatic brain injuries and abnormal computed tomography scans(2017) ROSI JUNIOR, Jefferson; WELLING, Leonardo C.; SCHAFRANSKI, Marcelo; YENG, Lin Tchia; PRADO, Rogerio Ruscito do; KOTERBA, Edwin; ANDRADE, Almir Ferreira de; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaTraumatic brain injury (TBI) is an important cause of death and disability worldwide. The prognosis evaluation is a challenge when many variables are involved. The authors aimed to develop prognostic model for assessment of survival chances after TBI based on admission characteristics, including extracranial injuries, which would allow application of the model before in-hospital therapeutic interventions. A cohort study evaluated 1275 patients with TBI and abnormal CT scans upon admission to the emergency unit of Hospital das Clinicas of University of Sao Paulo and analyzed the final outcome on mortality. A logistic regression analysis was undertaken to determine the adjusted weigh of each independent variable in the outcome. Four variables were found to be significant in the model: age (years), Glasgow Coma Scale (3-15), Marshall Scale (MS, stratified into 2,3 or 4,5,6; according to the best group positive predictive value) and anysochoria (yes/no). The following formula is in a logistic model (USP index to head injury) estimates the probability of death of patients according to characteristics that influence on mortality. We consider that our mathematical probability model (USP Index) may be applied to clinical prognosis in patients with abnormal CT scans after severe traumatic brain injury.