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The 5% 5-fluorouracil (5-FU) cream, considered the gold standard topical treatment, and peeling using 70% glycolic acid (GA) followed by 5% 5-FU are methods for the treatment of actinic keratoses (AKs). However, the comparison of these two treatments had not yet been described and therefore was the objective of this study. A randomized clinical trial, intrapatient study in which 17 patients received a type of treatment in the right and left upper limb with 5% 5-FU cream (twice daily) or a peeling application of 70% GA (every 15 days) followed by 5% 5-FU cream. There was a significant reduction of 75% and 85.71% in the mean number of AK lesions and of 74.5% and 85.71% in the size of lesions on the upper limbs of patients treated with peeling and 5% 5-FU cream (P-value ≤.001), respectively. Neither treatment was superior to the other since there was no significant difference (P-value ≥.05) between the treatments, both at the post-intervention period as well as when comparing the difference between the pre and post-intervention periods. The peeling with 70% GA followed by 5% 5-FU as well as 5% 5-FU cream are effective methods for the treatment of AKs on upper limbs.

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BACKGROUND: Venous ulcer represents the most advanced stage of chronic venous insufficiency. It is an important public health problem and has a significant impact on patients' quality of life due to chronic pain, inability to work, need for hospitalization and frequent outpatient follow-up. OBJECTIVE: We investigated the treatment benefits of far-infrared ceramic (cFIR), in a 90-day study of lower limb venous ulcers and looked at ulcer healing scores, quality of life, serum bio-markers of oxidative stress and antioxidant defense enzymes. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This is a randomized double-blind placebo-controlled study conducted in the Vascular Surgery Service of a hospital located in the northwest region of the State of Rio Grande do Sul, Brazil. We included patients with lower limb venous ulcers who were randomized to use either a bioceramics wrap or a placebo wrap for 90 days. MAIN OUTCOME MEASURES: The following evaluations were conducted at baseline and after 15, 30, 60 and 90 days: ulcer healing score, quality of life, and serum markers of oxidative stress and antioxidant enzyme activity. RESULTS: Patients (n = 24) with lower limb venous ulcers were randomized into two treatment groups. cFIR decreased the ulcer size on day 30 (P = 0.042) and 90 (P = 0.034) and the total ulcer healing scale scores on day 30 (P = 0.049) and 90 (P = 0.02) of the treatment, when compared to baseline. Additionally, cFIR improved tissue type (epithelial tissue) on day 60 (P = 0.022) when compared to baseline evaluation. CONCLUSION: cFIR clinically improved ulcer healing in patients with lower limb venous ulcers. TRIAL REGISTRATION: RBR-8c7xzn on ReBEC.

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BACKGROUND: Few studies have evaluated preoperative respiratory muscle strength as a risk factor for postoperative morbidity and mortality. The objective of this study was to evaluate the association of preoperative inspiratory muscle weakness (IMW) and preoperative expiratory muscle weakness (EMW) with duration of mechanical ventilation, length of stay in the intensive care unit (ICU), incidence of postoperative pulmonary complications (PPCs), and mortality in patients undergoing elective cardiac surgery. MATERIALS AND METHODS: This was a prospective observational study. Patients admitted for elective cardiac surgery were recruited. Maximal inspiratory and expiratory pressure were measured before surgery. A multivariate regression model was used to adjust for possible confounding variables and test the association of IMW and EMW with the duration of mechanical ventilation, length of stay in the ICU, PPCs, and hospital mortality. RESULTS: Two hundred and fifty-five patients were included in this study. The presence of IMW was associated with an increase in the duration of mechanical ventilation (P = .012). The presence of EMW was associated with a reduction in the incidence of PPCs (P = .005). IMW had no significant association with length of stay in the ICU, PPCs, or hospital mortality. EMW had no significant association with the duration of mechanical ventilation, length of stay in the ICU, or hospital mortality. CONCLUSIONS: In patients undergoing elective cardiac surgery, preoperative IMW is associated with the duration of mechanical ventilation while preoperative EMW is associated with a decrease in PPCs.

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BACKGROUND: Maximal inspiratory pressure (PImax) and 6-minutes walk distance test (6MWD) may be more available and feasible alternatives for prognostic assessment than cardiopulmonary testing. We hypothesized that the PImax and 6MWD combination could improve their individual accuracy as risk predictors. We aimed to evaluate PImax ability as a mortality predictor in HF and whether the combination to 6MWD could improve risk stratification. METHODS: Prospective cohort from HF Clinics of three University Hospitals. PImax, 6MWD and pVO2 were obtained at baseline. The end point was all cause mortality. RESULTS: Consecutive 256 individuals (50% woman, 57.4±10.4years) with low ejection fraction (LVEF) (31.8±8.6%) were followed up to 10years. During a median follow-up of 34.7 (IQR 37) months, 110 participants died. Mean±SD values were: pVO2 14.9±5.1mL/kg/min, PImax 5.5±1.3kPa and 6MWD 372±118m. In multivariate Cox regression, pVO2, PImax, 6MWD and LVEF were independent mortality predictors. The pVO2 showed gold standard accuracy, followed by PImax (AUC = 0.84) and 6MWD (AUC = 0.74). Kaplan-Meier mean survival time (MST±SE) for lower (≤5.0kPa) and higher (>6.0kPa) PImax tertiles, were 37.9±2.8months and 105.0±5.2months respectively, and addition of 6MWD did not restratified risk. For intermediate PImax tertile, MST was 81.5±5.5months, but adding 6MWD, MST was lower (53.3±7.6months) if distance was ≤350m and higher (103.1±5.7months) for longer distances. CONCLUSION: PImax is an independent mortality predictor in HF, more accurate than 6MWD and LVEF. Addition of 6MWD empowers risk stratification only for intermediate PImax tertile. Although less accurate than pVO2, this simpler approach could be a feasible alternative as a prognostic assessment.

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BACKGROUND: This small clinical trial tested the hypothesis that the addition of inspiratory muscle training (IMT) to aerobic exercise training (AE) results in further improvement in cardiorespiratory responses to exercise than those obtained with AE in patients with chronic heart failure (CHF) and inspiratory muscle weakness (IMW). METHODS: Twenty-four patients with CHF and IMW (maximal inspiratory pressure <70% of predicted) were randomly assigned to a 12-week program of AE plus IMT (AE + IMT, n = 12) or to AE alone (AE, n = 12). Before and after intervention, the following measures were obtained: maximal inspiratory muscle pressure (PI(max)), peak oxygen uptake (Vo(2)peak), peak circulatory power, oxygen uptake efficiency slope, ventilatory efficiency, ventilatory oscillation, oxygen uptake kinetics during recovery (T(1/2)Vo(2)), 6-minute walk test distance, and quality of life scores. RESULTS: Compared to AE, AE + IMT resulted in additional significant improvement in PI(max) (110% vs 72%), Vo(2)peak (40% vs 21%), circulatory power, oxygen uptake efficiency slope, ventilatory efficiency, ventilatory oscillation, and T(1/2)Vo(2). Six-minute walk distance and quality of life scores improved similarly in the 2 groups. CONCLUSION: This randomized trial demonstrates that the addition of IMT to AE results in improvement in cardiorespiratory responses to exercise in selected patients with CHF and IMW. The clinical significance of these findings should be addressed by larger randomized trials.

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OBJECTIVES: We tested the hypothesis that inspiratory muscle loading could result in exaggerated peripheral vasoconstriction in resting and exercising limbs and that inspiratory muscle training (IMT) could attenuate this effect in patients with chronic heart failure (CHF) and inspiratory muscle weakness. BACKGROUND: Inspiratory muscle training improves functional capacity of patients with CHF, but the mechanisms of this effect are unknown. METHODS: Eighteen patients with CHF and inspiratory muscle weakness (maximal inspiratory pressure <70% of predicted) and 10 healthy volunteers participated in the study. Inspiratory muscle loading was induced by the addition of inspiratory resistance of 60% of maximal inspiratory pressure, while blood flow to the resting calf (CBF) and exercising forearm (FBF) were measured by venous occlusion plethysmography. For the patients with CHF, blood flow measurements as well as ultrasound determination of diaphragm thickness were made before and after a 4-week program of IMT. RESULTS: With inspiratory muscle loading, CHF patients demonstrated a more marked reduction in resting CBF and showed an attenuated rise in exercising FBF when compared with control subjects. After 4 weeks of IMT, CHF patients presented hypertrophy of the diaphragm and improved resting CBF and exercise FBF with inspiratory muscle loading. CONCLUSIONS: In patients with CHF and inspiratory muscle weakness, inspiratory muscle loading results in marked reduction of blood flow to resting and exercising limbs. Inspiratory muscle training improves limb blood flow under inspiratory loading in these patients.

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