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Open Journal of Rheumatology and Autoimmune Diseases 2022年第4期12卷 114-118页

作者： Rafael Giovani Misse alexandre moura dos santos Abrahão Fontes Baptista Samuel Katsuyuki Shinjo Division of Rheumatology Faculdade de Medicina FMUSP Universidade de S&#227 o Paulo S&#227 o Paulo Brazil Center for Mathematics Computation and Cognition Federal University of ABC (UFABC) S&#227 o Bernardo do Campo Brazil

To the best of our knowledge, this is the first report in the literature showing the efficacy of transcranial direct current stimulation (tDCS) in treating refractory post-herpetic neuralgia in a patient with dermatomyositis. In addition, our results showed that tDCS sessions are safe and do not lead to disease relapse. Therefore, despite the limitations of being a case report, this study provides encouraging results that need to be widely explored in studies with a representative number of patients and with an appropriate design for patients with this systemic rheumatic autoimmune disease.

关键词： Cerebral Neuromodulation Dermatomyositis Neuralgia Pain Treatment

Pain and Fatigue Perceptions of Patients with Systemic Autoimmune Myopathies before and during the COVID-19 Pandemic Period

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Open Journal of Rheumatology and Autoimmune Diseases 2022年第4期12卷 83-98页

作者： Rafael Giovani Missé Isabela Bruna Pires Borges Bruna Lindoso Correia Lorenza Rosa Silvério da Silva Marlise Sítima Mendes Simões alexandre moura dos santos Samuel Katsuyuki Shinjo Division of Rheumatology Faculdade de Medicina FMUSP Universidade de Sao Paulo Brazil

Objective: To assess general pain and fatigue and their association with the disease status of patients with systemic autoimmune myopathies (SAMs), in terms of the impact of the COVID-19 pandemic on these parameters. Methods: This is a cross-sectional and prospective cohort study that included 72 patients with SAMs who were matched by age and gender with 67 healthy individuals. The patients engaged in an interview via a validity survey to measure disease status, and assess a visual analog scale (VAS) for pain and fatigue in two periods: before (phase I) and during (phase II) of the Brazilian COVID-19 pandemic. For cross-sectional analysis, patients’ data from phase I were compared to healthy individuals’ information, whereas for prospective analysis, data of the patients who were assessed in phase II were compared to the same patients’ data from phase I. Results: The patients had significantly more pain perception, comparable fatigue perception and fatigue severity, when compared to the healthy individuals. During the COVID-19 pandemic period, the disease activity, pain and fatigue perceptions, and fatigue severity remained unchanged. Despite this, the pain and fatigue perceptions correlated significantly with patients’ VAS, the patient health outcome, and fatigue severity. In addition, the pain perception correlated to creatine phosphokinase, whereas fatigue perceptions correlated to physicians' VAS. Conclusions: The study showed that patients with SAMs have significantly increased pain perceptions compared to healthy individuals. During the COVID-19 pandemic period, the pain and fatigue perceptions remained unchanged in patients with SAMs but they correlated to several disease status parameters.

关键词： COVID-19 Pandemic Fatigue Inflammatory Myopathies Myositis Physical Activity

Impact of an Exercise Training Program in a Patient with Relapsing Polychondritis: A Case Report

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Open Journal of Rheumatology and Autoimmune Diseases 2018年第3期8卷 93-98页

作者： alexandre moura dos santos Diego Sales de Oliveira Rafael Giovani Misse Letícia Alves Perin Jean Marcos de Souza Fernanda Rodrigues Lima Rosa Maria Rodrigues Pereira Samuel Katsuyuki Shinjo Division of Rheumatology Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de Sao Paulo Sao Paulo Brazil

Background: Exercise training has demonstrating to be safe and promote benefits for several rheumatologic autoimmune diseases. However, no study has evaluated the safety and benefits of exercise in relapsing polychondritis. Aim: To evaluate the effectiveness of an exercise training program in a patient with relapsing polychondritis. Case presentation: A 67-year-old female patient with relapsing polychondritis in remission was submitted to a 12-week, twice weekly, aerobic and resistance training program. Aerobic capacity, muscle strength and function capacity, as well as body composition, were evaluated at baseline and after 12-weeks. Conclusions: Exercise training program demonstrated to be effective for increasing aerobic capacity, muscle strength and function, and for improving body composition in the patient. Further studies are necessary to confirm these findings.

关键词： Exercise Training Relapsing Polychondritis Aerobic Training Resistance Training

Effects of Exercise Training on Endothelial Function,Arterial Structure,and Physical Conditioning in Patients with Systemic Autoimmune Myopathies:A Case Series Study

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Open Journal of Rheumatology and Autoimmune Diseases 2019年第2期9卷 57-68页

作者： Rafael Giovani Misse Isabela Bruna Pires Borges alexandre moura dos santos Diego Sales de Oliveira Jean Marcos de Souza Bruno Gualano Valéria Aparecida Costa Hong Luis Aparecido Bortolotto Samuel Katsuyuki Shinjo Faculdade de Medicina FMUSP Universidade de Sao Paulo SP Brazil Hypertension Unit Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de Sao Paulo SP Brazil

Introduction. Exercise training has been effective in improving endothelial function and decreasing arterial stiffness in several systemic autoimmune diseases. However, to date, no studies have assessed patients with systemic autoimmune myopathies (SAM). Methods. Five female patients with definite SAM (3 dermatomyositis and 2 polymyositis) who underwent a 12-week, twice-a-week, exercise training program were assessed prospectively. The following parameters were assessed: endothelial function measured by flow-mediated dilatation (FMD), carotid femoral by pulse wave velocity (PWV), disease status by International Myositis Assessment & Clinical Studies Group (IMACS) set score, the ventilatory anaerobic threefold (VAT), respiratory compensation point (RCP), maximum effort (ME), maximal oxygen uptake (VO2max) measured by ergospyrometer, and strength and muscle function. Results. Mean age of the patients and duration of disease were 43.9 and 10.5 years, respectively. The median FMD and PWV were 10.2% and 7.1 m/s. After exercise training, important FMD reduction was observed in 4 out of 5 patients, whereas the PWV parameters decreased in only 2 out of 5 patients. The exercise training was safe, without clinical intercurrences or disease relapses. Moreover, an increase in strength and functionality was observed. Concerning aerobic capacity, there was a decrease in the VAT and an increase in ME, without al-terations in the maximum oxygen consumption. Conclusions. In general, exercise training does not alter endothelial function and PWV values, but improves muscle strength and function and also, does not lead to disease reactivation (Clinical Trials (NCT03092167)).

关键词： Dermatomyositis Endothelial Function Exercise Polymyositis Pulse Wave Velocity

Transcranial direct current electrical stimulation in combination with aerobic exercise:A pilot study in post-COVID-19 systemic autoimmune rheumatic patients

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World Journal of Rheumatology 2023年第1期11卷 1-12页

作者： Rafael Giovani Missé alexandre moura dos santos Isabela Bruna Pires Borges Marlise Sítima Mendes Simões Lorenza Rosa Silvério Bruna Lindoso Correia Ana Wook Sook Kim Aline Marques Caetano Sandra Gofinet Pasoto Carla Gonçalves Schahin Saad Diogo Souza Domiciano Clarice Tanaka Julia Maria D’Andrea Greve Abrahão Fontes Baptista Samuel Katsuyuki Shinjo Division of Rheumatology Hospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil Departamento de Fisioterapia Fonoaudiologia e Terapia OcupacionalHospital das Clínicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloNúcleo de Assistência e Pesquisa em NeuromodulaçãoSao PauloBrazil Laboratório de Estudos do Movimento Instituto de Ortopedia e TraumatologiaHospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil

BACKGROUND Systemic autoimmune rheumatic diseases(SARDs)are a group of diseases with multiorgan involvement and a high prevalence of chronic pain and *** with SARDs and post-coronavirus disease 2019(COVID-19)syndrome experience aggravation of *** this context,it is essential to establish strategies to reduce chronic pain and fatigue and improve quality of *** To assess the efficacy of transcranial direct current stimulation(tDCS)for the treatment of fatigue and pain-associated post-COVID-19 syndrome in patients with *** This study included nine patients with different types of *** patients had reverse transcription-polymerase chain reaction(RT-PCR)test confirmed COVID-19 as well as significant,persistent fatigue and pain that began to worsen after *** tDCS was administered in five daily sessions(2mA,20 min).Concomitantly,patients were involved in aerobic exercise *** participants were evaluated using specific questionnaires and strength assessment by handgrip and physical function by timed-up-and-go test and sit-to-stand test at baseline(within one week before tDCS protocol),and one week after tDCS *** all procedures,the patients’treatments remained *** The sample comprised eight women and one man with a mean age of 48.7±9.6 *** the tDCS protocol,pain and fatigue significantly improved on the visual analog scale(P<0.05).The physical function also improved 9.5±2.7 vs 6.8±0.8(P=0.001)for timed-up-go-test and 10.3±3.7 vs 15.1±4.0(P=0.037)for sit-to-stand *** of the patients experienced any adverse *** The present study showed that tDCS in combination with aerobic exercise was effective in improving physical function,and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.

关键词： Autoimmune diseases COVID-19 Fatigue Neuromodulation Physical function Rheumatic diseases Pain

Rescuing agroforestry as strategy for agriculture in Southern Brazil

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Journal of Forestry Research 2016年第4期27卷 739-746页

作者： alexandre Siminski Karine Louise dos santos Juliano Gil Nunes Wendt Universidade Federal de Santa Catarina Centro de Curitibanos

Knowledge about agricultural ecosystems, as well as about ecological and social interactions that occur in an agricultural context, is essential to promote a balanced environment for production. Incorporating the forest landscape into farming systems has promoted the development of integrated production systems such as agroforestry. However, many aspects of the relationship between farming and the forest landscape have changed since the modernization of agriculture introduced by the Green Revolution. The objectives of this review are：（1） to contribute to the understanding of the changes in cultivation strategies and in the dynamics of agricultural systems,particularly in the context of farming in Santa Catarina State, Brazil;（2） to contribute to the understanding of agroforestry systems as a strategy to reintroduce the element of forestry into agricultural production systems; and（3） to compile a list of forest plant species that could be used in agroforestry. The approach adopted in this manuscript seeks to highlight the potential of agroforestry systems to conserve natural resources and thereby to support agricultural development by connecting environmental conservation with income for farmers.

关键词： agriculture agricultural farming Brazil landscape cultivation modernization highlight income compile

Adjuvant therapy for gastric cancer:What have we learned since INT0116?

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World Journal of Gastroenterology 2015年第13期21卷 3850-3859页

作者： alexandre A Jácome Ajith K Sankarankutty José Sebastiao dos santos Department of Medical Oncology Hospital Mater DeiBelo Horizonte 30190-131Minas GeraisBrazil Department of Surgery and Anatomy University of Sao Paulo at Ribeirao PretoSchool of MedicineRibeirao Preto14049-900Sao PauloBrazil

Gastric cancer is one of the main cancer-related causes of death worldwide. The curative treatment of gastric cancer consists of tumor resection and lymphadenectomy. However, surgical treatment alone is associated with high recurrence rates. Adjuvant treatment strategies have been studied over the last decades, but there have been controversial results from the initial studies. The pivotal INT0116 study demonstrated that the use of adjuvant chemoradiotherapy with 5-fluorouracil increases relapse-free and overall survival, and it has been adopted across the Western world. The high toxicity of radiochemotherapy and suboptimal surgical treatment employed, with fewer than 10% of the patients submitted to D2 lymphadenectomy, were the main study limitations. Since its publication, other adjuvant treatment modalities have been studied, and radiochemotherapy is being refined to improve its efficacy and safety. A multimodal approach has been demonstrated to significantly increase relapsefree and overall survival, and it can be offered in the form of perioperative chemotherapy, adjuvant chemoradiotherapy or adjuvant chemotherapy, regardless of the extent of lymphadenectomy. The objective of the present review is to report the major advances obtained in the last decades in the adjuvant treatment of gastric cancer as well as the perspectives of treatment based on recent knowledge of the molecular biology of the disease.

关键词： Stomach neoplasms Adjuvant radiotherapy Adjuvant chemotherapy Histology Genes erbB-2

Dealing with Multisource Information for Estuarine Flood Risk Appraisal in Two Western European Coastal Areas

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International Journal of Disaster Risk Science 2022年第2期13卷 199-213页

作者： Ana Rodrigues Rilo alexandre Manuel de Oliveira Soares Tavares Paula Maria dos santos Freire José Luis Zêzere Estuarine and Coastal Zones Unit LNEC-National Civil Engineering Laboratory.1700-075 LisbonPortugal Centre of Geographical Studies Institute of Geography and Spatial PlanningUniversidade de Lisboa1700-066 LisbonPortugal Centre for Social Studies and Earth Sciences Department Coimbra University3030-790 CoimbraPortugal

Estuaries are usually affected by compound flooding triggers that cause diverse territorial *** fluvial flood risk assessment frameworks are well established in the literature,integrated management instruments that deal with estuarine flood risk remain incomplete and often *** research presents a methodology to extract relevant information from multiple sources post-event and a database building process that is applied to two contrasting estuaries(the Tagus River estuary in Portugal,and the Shannon River estuary in Ireland)in the Western European coastal ***,a total of 274 documents were analyzed and the information was stored in two *** correspondence analysis was applied to extract the most informative and relevant estuarine flood *** integrated estuarine flood risk assessment framework is presented and discussed based on the extracted *** framework is driven by two distinct dimensions(oceanic and hydrographic)and revealed the transversal position of triggers of estuarine floods,reflecting the compounding effects usually present in these *** results also highlight two levels of flood risk mostly based on damage typology.

关键词： Estuarine floods Estuarine flood indicators Multiple correspondence analysis Post-hazard multisource information Western Europe

Personalized medicine in gastric cancer:Where are we andwhere are we going?

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World Journal of Gastroenterology 2016年第3期22卷 1160-1171页

作者： alexandre A Jácome Anelisa K Coutinho Enaldo M Lima Aline C Andrade JoséSebastião dos santos Department of Medical Oncology Hospital Mater DeiBelo Horizonte 30190-131Minas GeraisBrazil Department of Gastrointestinal Oncology Brazilian Gastrointestinal Tumor GroupClinica AMOSalvador 41950-640BahiaBrazil Department of Surgery and Anatomy University of São Paulo at Ribeirão PretoSchool of MedicineRibeirão Preto14049-900São PauloBrazil

Despite improvements in adjuvant therapies for gastric cancer in recent years, the disease is characterized by high recurrence rates and a dismal prognosis. The major improvement in the treatment of recurrent or metastatic gastric cancer in recent years has been the incorporation of trastuzumab, a monoclonal antibody that inhibits human epidermal growth factor receptor 2(HER2) heterodimerization, after the demonstrated predictive value of the overexpression and/or amplification of this receptor. Beyond HER2, other genetic abnormalities have been identified, and these mutations may be targetable by tyrosine kinase inhibitors or monoclonal antibodies. The demonstration of four distinct molecular subtypes of gastric cancer by the Cancer Genome Atlas study highlight the enormous heterogeneity of the disease and its complex interplay between genetic and epigenetic alterations and provide a roadmap to implement genome-guided personalized therapy in gastric cancer. In the present review, we aim to discuss, from a clinical point of view, the genomic landscape of gastric cancer described in recent studies, the therapeutic insights derived from these findings, and the clinical trials that have been conducted and those in progress that take into account tailored therapies for gastric cancer.

关键词： stomach neoplasms biological markers Molecular targeted therapy Individualized medicine Transcriptome

Genetic diversity and structure of Drimys brasiliensis in southern Brazil:insights for conservation

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Journal of Forestry Research 2020年第4期31卷 1325-1332页

作者： alexandre Mariot Tiago Montagna Maurício Sedrez dos Reis Núcleo de Pesquisas Em Florestas Tropicais Pós-Graduacāo Em Recursos Genéticos VegetaisCentro de Ciências AgráriasUniversidade Federal de Santa CatarinaRodovia Admar Gonzaga1346FlorianópolisSC 88034-000Brazil

Population genetics studies are widely recognized for generating useful knowledge for biodiversity *** date,however,little is known about the levels and distribution of genetic diversity of Drymis brasiliensis(Miers LC),a tree species from the Atlantic ***,in this study,we investigated how genetic diversity is distributed within and among populations of *** from southern Brazil using allozyme markers to genotype reproductive trees(8 populations)and seedlings(3 populations).Furthermore,in two populations,we established two permanent plots(5.1 and 1 ha)to analyze fine-scale genetic structure(FSGS).Studied populations presented low levels of genetic diversity(reproductive=0.085;seedlings=0.054)and high fixation indexes(reproductive=0.396;seedlings=0.231).Genetic divergence among populations was equal to 0.05,which is significant,signaling that few populations can conserve large portions of the species total genetic *** was only detected for one population,when reproductive individuals were separated by less than40 *** genetic diversity combined with high fixation indexes clearly signal a risk of losing ***,conservation efforts should be aimed at enhancing gene flow within the studied populations.

关键词： Atlantic Rainforest Effective population size Fine-scale genetic structure Seed collection