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Background Arm-crank exercise training (ACT) is an alternative exercise strategy for patients with symptomatic peripheral artery disease (PAD) due to the attenuation of pain symptoms during the exercise, as well as the benefits to functional capacity. Purpose The aim of this study is to describe the study protocol to analyze the effects of ACT exercise on cardiovascular function, functional capacity, cognition and quality of life in patients with symptomatic PAD. Methods This is a three-armed randomized, prospective, single-blind data collection, single-center, controlled study enrolling 45 patients with symptomatic PAD who will be randomized into 3 intervention groups: walking training (WT), ACT and control group. The WT and ACT will perform 2 sessions/week, 15 to 10 sets of 2 to 5 minutes at values of 13 to 15 on the Borg scale. Before and after 12 weeks of intervention, cardiovascular function (ambulatory blood pressure, office blood pressure, central blood pressure, heart rate variability, arterial stiffness and vascular function), functional capacity (six-minute walk test, 2 minute step test, handgrip test, Walking impairment questionnaire, Walking estimated limitation calculated by history, Baltimore activity scale for intermittent claudication, and short physical performance battery), cognition (executive function and memory), and quality of life (vascular quality of life questionnaire and World Health Organization Quality of Life) will be assessed. Results This is the first trial to evaluate the effects of ACT on regulatory mechanisms of the cardiovascular system in PAD patients. If the results are as expected, they will provide evidence the ability of ACT to promote cardiovascular benefits in the symptomatic PAD population.

Introduction The risk of malnutrition is an important predictor of functional capacity in the elderly population. However, whether malnutrition is associated with functional capacity in patients with peripheral artery disease (PAD) is poorly known. Purpose To analyse the association between the risk of malnutrition and functional capacity in patients with PAD. Methods This cross-sectional study included 135 patients with PAD of both genders, ≥50 years old, with symptomatic PAD (Rutherford stage I to III) in one or both limbs and with ankle-brachial index ≤0.90. The risk of malnutrition was assessed by the short form of the Mini Nutritional Assessment-Short Form and patients were classified as having normal nutritional status (n = 92) and at risk of malnutrition (n = 43). Functional capacity was objectively assessed using the six-minute walking test (6MWT, absolute maximal distance and relativized and expressed as a percentage of health subjects), short-physical performance battery (SPPB, balance, gait speed and the sit and stand test) and the handgrip test, and subjectively, using the Walking Impairment Questionnaire and Walking Estimated-Limitation Calculated by History. The association between the risk of malnutrition and functional capacity was analysed using bivariate and multivariate logistic regression adjustments for gender, age, ankle-brachial index, body mass index, use of statins, coronary arterial disease and stroke. For all statistical analyses, significance was accepted at p Results Thirty-two per cent of our patients were classified with a risk of malnutrition. The risk of malnutrition was associated with the absolute 6MWT total distance (OR = 0.994, P = 0.031) relative 6MWT total distance (OR = 0.971, P = 0.038), lowest SPPB total score (OR = 0.682, P = 0.011), sit and stand (OR = 1.173, P = 0.003) and usual 4-meter walk test (OR = 1.757, P = 0.034). Conclusion In patients with PAD, the risk of malnutrition was associated with objective measurements of functional capacity.

Orientador: Joyce Maria Annichino Bizzacchi Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: A síndrome pós-trombótica (SPT) é uma complicação presente em 20% 50% dos pacientes com antecedente de trombose venosa profunda (TVP) de membros inferiores, e está associada a um risco aumentado de recorrência de TVP, baixa qualidade de vida e custo significativo para a Saúde Pública. Os anticoagulantes orais diretos (DOACs) demostraram ser tão eficazes e mais seguros que a varfarina para o tratamento da TVP. Estudos mostraram que a rivaroxabana, um DOAC inibidor do fator X ativado (FXa), diminui a prevalência de SPT em comparação à varfarina. O objetivo deste estudo foi comparar a prevalência de SPT pela escala de Villalta, em pacientes com antecedente de TVP proximal de membros inferiores tratados com rivaroxabana ou varfarina. Como é descrita a associação entre inflamação, hipercoagulabilidade, presença de trombo venoso residual (TVR) e SPT, foram avaliados a presença de TVR e sua ecogenicidade (grayscale median; GSM), e os níveis dos marcadores interleucina (IL) 6, IL 8, fator de necrose tumoral ? (TNF ?), Dímero D, e metaloproteases (MMP) 9 e 10. Entre 2013-2019 foram incluídos 129 pacientes (71 tratados com rivaroxabana/58 com varfarina), selecionados do Hemocentro de Campinas (UNICAMP) e de 2 clínicas privadas em Campinas e Sorocaba, São Paulo. O período médio de tratamento dos pacientes foi de 6 meses com rivaroxabana e de 7 meses com varfarina. A escala de Villalta foi realizada 15 (10 24) e 61 (34-86,5) meses após a TVP, e a avaliação do TVR em 38,9 (24,6-55) e 66,7 (44,4-95,7) meses após o evento, nos grupos rivaroxabana e varfarina, respectivamente. A duração média dos sintomas da TVP antes do tratamento foi de 7 dias em ambos os grupos. A prevalência da SPT foi significativamente menor no grupo rivaroxabana em relação ao grupo varfarina (50,7% versus 69,0%; P=0,018). O risco relativo de SPT foi 76,0% menor com o uso da rivaroxabana comparado à varfarina (OR=0,24). Até 72 meses do início do estudo, os resultados de 93 ultrassons revelaram a presença de TVR em 42 pacientes [11 (24,4%) para rivaroxabana e 31 (64,6%) para varfarina (P

There is growing interest on the internet regarding treatment options for facial blushing and craniofacial hyperhidrosis. If patients seek medical help they should be advised to see a dermatologist or an internist to rule out serious underlying disorders before surgical options are discussed. Patients with emotionally triggered blushing should also be encouraged to try non-surgical options as the first line of treatment. Provided they fail this and there is still an indication for treatment, facial blushing may be treated effectively by sympathetic surgery. The key to success in sympathetic surgery for facial blushing lies in meticulous and critical patient selection, ensuring that patients are thoroughly informed about the high risk of adverse effects. With proper patient selection the majority of patients treated surgically are very satisfied with the result of the operation but approximately 10% regret the operation because of adverse effects. More quality research that compares surgical, non-surgical, and psychotherapeutic treatments is urgently needed.

Orientadores: Joyce Maria Annichino-Bizzacchi, Fernanda Loureiro de Andrade Orsi Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: A trombose venosa profunda (TVP) é uma doença multifatorial em que ocorre a formação de um trombo no interior de um vaso do sistema venoso profundo. Atualmente, os maiores desafios após um episódio trombótico são prevenção das sequelas tardias relacionadas à doença, como a recidiva e o surgimento de síndrome pós-trombótica (SPT), que podem ser observadas mesmo frente a um manejo anticoagulante adequado. A avaliação do trombo venoso residual como fator de risco para ambas as sequelas vem sendo estudada nos últimos anos, mas até hoje não houve um consenso entre estudos publicados em relação ao seu papel na recidiva da doença e na manutenção e gravidade da SPT, sendo o fator mais importante para a ausência de consenso a falta da padronização de uma metodologia adequada para avaliação desse trombo. Desta forma, o objetivo deste estudo foi avaliar se a presença e ecogenicidade do trombo venoso residual, evidenciada pela análise GSM (grayscale median) de imagens obtidas por ultrassonografia, poderia ser uma ferramenta na avaliação de complicações tardias da TVP: SPT e recidiva. Para a avaliação do papel do trombo residual na SPT, o modelo de estudo utilizado foi o transversal, e na recidiva, o prospectivo. Foram incluídos no estudo 56 pacientes com TVP de membros inferiores. No momento da inclusão no estudo, os pacientes foram submetidos a análise ultrassonográfica e coleta de sangue para dosagem de dímero-D. Esses pacientes foram acompanhados durante dois anos, quando foram reconvocados para a realização de um novo exame ultrassonográfico, avaliação clínica (para detecção de SPT e obesidade) e coleta de sangue para dosagem dos níveis de proteína C reativa (PCR). Dos 56 pacientes incluídos, 41 apresentaram SPT, sendo que a SPT leve foi detectada em 23 pacientes, SPT moderada em 11, e grave em 7. Pacientes com SPT grave eram predominantemente obesos, apresentaram níveis elevados de PCR e também foram caracterizados pela presença de trombo hipoecóico quando comparados aos pacientes com SPT leve-moderada ou com pacientes sem SPT. Em relação a recidiva da doença, 10 pacientes tiveram esse desfecho e todos apresentaram trombo residual ao ultrassom. Valores de dímero-d acima de 630 ng/mL conferiram alto risco para recorrência, a ausência de trombo residual teve um efeito protetor, e a presença do trombo residual hipoecóico mostrou ser um marcador preditivo do risco de recorrência. Esses resultados permitem concluir que pacientes que apresentam trombo hipoecóico, após a fase aguda da TVP, parecem ter uma pior evolução clínica em comparação aos pacientes que não apresentam trombo hipoecóico. Assim, a ecogenicidade do trombo residual pela análise GSM, poderia representar uma nova estratégia para avaliação do prognóstico em relação às complicações tardias da TVP Abstract: Deep venous thrombosis (DVT) is a multifactorial disease that occurs by formation of acute thrombus in the deep venous system. Currently, the major concerns related to DVT are the late sequelae, such as post-thrombotic syndrome (PTS) and DVT recurrence, that may appear even after adequate anticoagulation therapy. The evaluation of residual venous thrombosis (RVT) as a risk factor for both complications has been extensively studied in recent years, but there is no consensus among investigators regarding the role of RVT in the recurrence of DVT and maintenance and severity of PTS, probably due to a lack of a standardized methodology for thrombi evaluation. Thus, the aim of this study was to evaluate if the presence and echogenicity of RVT, evidenced by GSM analysis (grayscale median) of ultrasound images, could be tools to assess late sequelae of DVT. We performed a cross-sectional study designed to evaluate the role of RVT in PTS and a prospective study to evaluate DVT recurrence. Fifty-six patients with previous diagnosis of DVT of lower limbs were included in the study. At the time of inclusion, patients were submited to an ultrasound examination to detect RVT and blood collection for d-dimer measurements. These patients were followed for two years, when they were reconvened to perform a new ultrasound examination, clinical evaluation (to detect PTS and Obesity) and blood collection for measurements of C-reactive protein (CRP) levels. Of the 56 patients included, 41 presented PTS. Mild PTS was detected in 23 patients, moderate PTS in 11 and severe PTS in 7. Patients with severe PTS presented obesity, higher CRP levels and were characterized by the presence of hypoechoechoic RVT when compared to patients with mild-moderate PTS or no PTS. DVT recurrence was observed in 10 patients, all of which presented RVT. D-Dimer levels above 630ng/mL conferred higher risk for recurrence, the absence of RVT was a protective marker for recurrence and the presence of hypoechoic RVT presented predictive value for recurrence. These results indicate that patients with hypoechoic thrombus, after the acute episode of DVT, seem to have a worse clinical outcome compared to patients without hypoechoic thrombus. Thus, the echogenicity of the RVT, by GSM analysis, could represent a new strategy for prognostic evaluation related to late sequelae of DVT Doutorado Fisiopatologia Médica Doutora em Ciências FAPESP 2012/14082-6