JANINI CHEN
Projetos de Pesquisa
Unidades Organizacionais
P IOT, Hospital das Clínicas, Faculdade de Medicina
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
- Gait, posture and cognition in Parkinson's disease(2016) BARBOSA, Alessandra Ferreira; CHEN, Janini; FREITAG, Fernanda; VALENTE, Debora; SOUZA, Carolina de Oliveira; VOOS, Mariana Callil; CHIEN, Hsin FenABSTRACT Gait disorders and postural instability are the leading causes of falls and disability in Parkinson's disease (PD). Cognition plays an important role in postural control and may interfere with gait and posture assessment and treatment. It is important to recognize gait, posture and balance dysfunctions by choosing proper assessment tools for PD. Patients at higher risk of falling must be referred for rehabilitation as early as possible, because antiparkinsonian drugs and surgery do not improve gait and posture in PD.
article 44 Citação(ões) na Scopus Anti-Nerve Growth Factor in the Treatment of Low Back Pain and Radiculopathy: A Systematic Review and a Meta-Analysis(2014) LEITE, Victor F.; BUEHLER, Anna M.; ABD, Omar El; BENYAMIN, Ramsin M.; PIMENTEL, Daniel C.; CHEN, Janini; HSING, Wu Tu; MAZLOOMDOOST, Danesh; AMADERA, Joao E. D.Background: Low back pain with or without radiculopathy is an important cause of disability and economic expenditure. However, many patients are not meeting optimal pain control through existing treatments. Recent studies have linked nerve growth factor (NGF) and the pathophysiology of persistent pain. Anti-NGF could be an alternative drug treatment for low back pain. Objective: Systematically review the efficacy and safety of anti-NGF in the treatment of low back pain. Methods: A systematic review of the literature with no language, date or publication status restriction, using Medline, EMBASE, Cochrane Library, and the clinicaltrials. gov database. Additional literature was retrieved by conferring with experts in the field or reviewing bibliographies and annals of meetings and congresses. Search terms included ""monoclonal antibodies,"" "" nerve growth factor,"" ""anti-ngf,"" ""fulranumab,"" ""tanezumab,"" "" sciatica,"" "" back pain,"" and ""spine."" Study Design: Inclusion criteria were observational studies with safety as an outcome and randomized or nonrandomized controlled trials studying the efficacy and/or the safety of anti-NGF drugs on low back pain. Exclusion criteria included patients with autoimmune conditions or osteoporosis. Studies were assessed independently by 2 authors regarding inclusion/exclusion criteria, risk of bias, clinical relevance, and quality of evidence (GRADE approach). Results: 1,168 studies were retrieved. After excluding duplicates and applying the inclusion/exclusion criteria, 4 RCTs remained (n = 2,109): 2 for tanezumab, one for REGN475, and one for fulranumab. Only the tanezumab studies showed any significant difference over placebo (n = 1,563) for both pain relief and functional improvement. Conclusions: There is very low evidence that systemically administered anti-NGF therapy has a small positive effect compared to placebo for both pain relief (standarized mean difference [SMD] = -0.29, 95% confidence interval [CI] -0.58 to 0.00) and functional improvement (SMD = -0.21, 95% CI -0.37 to -0.05) of low back pain. There was low evidence of adverse effects (AEs) compared to placebo and low evidence of neurological AEs than placebo (relative risk = 1.93, 95% CI 1.41 to 2.64). Tanezumab, as a specific anti-NGF treatment, showed low evidence of a small to moderate effect for pain relief of low back pain (SMD = -0.44, 95% CI -0.81 to -0.07); and low evidence of a small effect for functional improvement (SMD = -0.26, 95% CI -0.40 to -0.12) with systemic administration, although not clinically significant. Tanezumab and anti-NGFs overall had, respectively, moderate and low evidence of overall AEs and serious AEs and a higher risk of developing neurological AEs when compared with placebo. Although anti-NGF, specifically tanezumab, showed a low-to-moderate effect on pain relief and functional improvement, it cannot be recommended for low back pain treatment. Without more research on the pathophysiology of anti-NGFs and adverse effects, its use is not safe in the overall population. However, as corroborated by the US Food and Drug Administration, this meta-analysis underscores a role for greater insight into anti-NGF therapy for painful conditions that are refractory to current drugs, such as oncologic pain, chronic pancreatitis, and phantom-limb pain. Given the pathophysiology of axial pain involving inflammatory mediators and the adverse effects of systemic anti-NGF use, consideration of local therapies may warrant further exploration.- Changes in Pressure Pain Threshold in Patients With Chronic Nonspecific Low Back Pain(2013) IMAMURA, Marta; CHEN, Janini; MATSUBAYASHI, Suely Reiko; TARGINO, Rosa A.; ALFIERI, Fabio Marcon; BUENO, Daniel Kamura; HSING, Wu TuStudy Design. Cross-sectional study. Objective. The purpose of this study is to compare pressure pain threshold (PPT) values between patients with chronic nonspecific low back pain (CLBP) and healthy individuals and correlate PPT values of the structures investigated with demographic and clinical data from patients with CLBP. Summary of Background Data. Chronic pain may decrease pain tolerance of almost the entire spinal cord segment; however, previous studies on PPT in patients with low back pain have limited their focus to evaluating only patient complaints. Methods. Forty subjects participated in the study: 20 with a clinical diagnosis of CLBP and 20 healthy individuals. Outcome measures were PPT values of myotomes, sclerotomes, and dermatomes corresponding to segments L1 to S3; demographic, clinic, and social data; visual analogue scale, and Roland and Morris Questionnaire. Results. Most analyzed structures had lower PPT values in patients with CLBP than in healthy individuals on both sides (bilaterally). PPT correlated positively with height and pain duration (P < 0.05) and negatively with body mass index in the suprainterspinous ligament between L2 and L3 and dermatomes L5 to S2 (P < 0.05). Conclusion. Our results showed that individuals with CLBP have lower PPT values than healthy individuals in almost all assessed structures. We propose a simple approach that can differentiate patients with CLBP whose hyperalgesia in the painful area may be the result of several mechanisms that should be further investigated, such as sensitization of the central nervous system.
conferenceObject Executive function and verbal fluency in patients with Parkinson's disease(2016) BARBOSA, A. F.; VOOS, M. C.; SOUZA, C. O.; CHEN, J.; CHIEN, H. F.; FRANCATO, D. V.; BARBOSA, E. R.; MANSUR, L. L.article 30 Citação(ões) na Scopus Anti-Tumor Necrosis Factor Antagonists in the Treatment of Low Back Pain and Radiculopathy: A Systematic Review and Meta-analysis(2014) PIMENTEL, Daniel C.; ABD, Omar El; BENYAMIN, Ramsin M.; BUEHLER, Anna M.; LEITE, Victor F.; MAZLOOMDOOST, Danesh; CHEN, Janini; HSING, Wu Tu; AMADERA, Joao E. D.Background: Low back pain, with or without radiculopathy, is an important cause of disability and economic expenditure. However, many patients are not achieving optimal pain control with existing medications. Tumor necrosis factor antagonists (anti-TNF alpha) could be an alternative drug treatment. Objectives: Systematic review the efficacy and safety of anti-TNF alpha in the treatment of low back pain with or without radiculopathy. Study Design: Inclusion criteria were observational studies with safety as an outcome, and randomized or nonrandomized controlled trial (RCT) studies on efficacy and/or safety of anti-TNF alpha drugs on low back pain. Exclusion criteria included patients with auto-immune conditions or osteoporosis. Results: Studies were assessed independently by 2 authors regarding inclusion/exclusion criteria, risk of bias, clinical relevance, quality, and strength of evidence (GRADE approach). Of the 1,179 studies retreived, all duplicates were excluded and then the inclusion/exclusion criteria was applied. One observational study (n = 143) and 11 RCTs remained (n = 539): 8 for etanercept (n = 304), one for adalimumab (n = 61), one for adalimumab and etanercept (n = 60), one for infliximab (n = 40) and one for REN-1654 (n = 74). Only 3 etanercept and 2 adalimumab studies showed statistically significant pain relief when compared to placebo. There was no difference in the overall incidence of adverse effects when comparing anti-TNF-alpha and placebo. Limitations: Despite the statistically significant effect, this meta-analysis has important limitations, such as high heterogeneity and high use of outcome imputation. Conclusions: There is low evidence that epidural etanercept has a low-to-moderate effect size when compared to placebo for pain due to discogenic lumbar radiculopathy (5 studies, n=185), with a standardized mean difference = -0.43 (95% confidence interval [CI] -0.84 to -0.02). There is moderate evidence that epidural etanercept does not have a higher adverse effects incidence rate when compared to placebo for discogenic lumbar radiculopathy (5 studies, n = 185) with a relative risk (RR) = 0.84 (95% CI 0.53 to 1.34). There is moderate evidence that anti-TNF alpha does not have a higher adverse effects incidence rate when compared to placebo for low back pain (10 studies, n= 343) with an RR = 0.93 (95% CI 0.56 to 1.55). We strongly suggest that anti-TNF alpha continue to be studied in experimental settings for the treatment of low back pain. We cannot currently recommend this therapy in clinical practice. New research could shed some light on the efficacy of anti-TNF alpha and change this recommendation in the future.conferenceObject The effect of muscular strenghtening exercise in motor function and balance in Parkinson's disease patients(2014) CHIEN, H. F.; CHEN, J.; SOUZA, C. O.; VOOS, M. C.; FRQANCATO, D. V.; BARBOSA, A.; GREVE, J. M.; BARBOSA, E. R.conferenceObject Evaluation of motor and cognitive performance in Parkinson's disease patient with high and low educational status(2014) SOUZA, C. O.; VOOS, M. C.; CHIEN, H. F.; CHEN, J.; FRANCATTO, D. V.; BARBOSA, A.; FONOFF, E. T.; GREVE, J. M.; BARBOSA, E. R.conferenceObject Executive function and educational status interfere with functional balance and locomotion in individuals with Parkinson's disease(2013) SOUZA, C. O.; VOOS, M. C.; CHEN, J.; FRANCATO, D.; CHIEN, H. F.; FONOFF, F.; GREVE, J.; FONOFF, E. T.; BARBOSA, E. R.conferenceObject The addition of a concurrent task changes postural reactions in individuals with Parkinson's disease(2013) SOUZA, C. O.; VOOS, M. C.; CHEN, J.; FRANCATO, D.; CHIEN, H. F.; FONOFF, F.; FONOFF, E.; GREVE, J.; BARBOSA, E. R.- Is virtual reality beneficial for dual-task gait training in patients with Parkinson's disease? A systematic review(2019) FREITAG, Fernanda; BRUCKI, Sonia Maria Dozzi; BARBOSA, Alessandra Ferreira; CHEN, Janini; SOUZA, Carolina de Oliveira; VALENTE, Débora Francato; CHIEN, Hsin Fen; BEDESCHI, Cynthia; VOOS, Mariana CallilABSTRACT This systematic review examined the evidence about the effects of virtual reality (VR) on dual-task gait training in Parkinson's disease (PD). Methods: this study (PROSPERO registration CRD42019114736) aimed to answer the question: “Is VR beneficial for dual-task gait training in patients with PD?” We searched for studies from 2008 to 2018 on Medline/PubMed and Web of Science/Web of knowledge databases. The keywords were Parkinson AND gait training AND virtual reality OR Parkinson AND gait training AND game. A total of 55 articles were retrieved, of which 11 systematic reviews, 11 opinions, letters to the editor, posters or conferences abstracts and 17 studies not evaluating the effects of VR gait training were excluded. Three further studies addressing VR dual-task gait training in PD (found in references of studies selected) were also included. Therefore, 19 studies were included and analysed. Results: all studies reported gait improvement after VR training. Many clinical scales were used, hampering comparison of the effects of each protocol. Conclusion: VR dual-task gait training should be part of rehabilitation protocols for PD. The studies showed that VR training was effective, although specific guidelines have not yet been established.