Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE) (State Government Employee Medical Assistance Institute) is an economically self-sufficient governmental health system in the Brazilian State of São Paulo that attends to the health needs of state government employees, their families, and dependents. It is a huge institution, and includes the State Government Employee Hospital (Hospital do Servidor Público Estadual) "Francisco Morato de Oliveira" (HSPE-FMO) in the capital, São Paulo, inaugurated in July 1961.It was founded in 1952 as Departamento de Assistência Médica ao Servidor Público (DAMSPE) in the State of São Paulo. In 1961, it was opened as HSPE-FMO and 1966 it became IAMSPE.According to Brazilian laws, only government workers of São Paulo State presenting their payslips with the monthly contributions have the right to use the hospital complexes..
Left bundle branch pacing (LBBP) and left bundle fascicular pacing (LBFP) are conduction system pacing techniques that preserve physiological ventricular activation. Whether proximal or distal capture yields superior electrical or echocardiographic outcomes is uncertain. To systematically evaluate and compare LBFP versus left bundle branch trunk pacing (LBBP) in terms of electrical synchrony and echocardiographic characteristics in patients requiring permanent cardiac pacing. We searched PubMed, Embase, and Cochrane through May 21, 2025, for randomized and observational studies comparing LBFP with LBBP. Outcomes of interest included QRS duration, V6 R-wave peak time (RWPT), left ventricular activation time (LVAT), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and pacing thresholds. Statistical analysis was performed using a random-effects model, with heterogeneity assessed using I² statistics. Risk of bias was evaluated using the ROBINS-I. Six studies involving 2,989 patients (1,241 LBFP; 249 LBBP) were included. There were 3 prospective studies, 2 retrospective, and 1 that was both prospective and retrospective. There were no RCTs on this subject. LBFP was associated with a statistically shorter V6-RWPT (mean difference: − 3.50 ms; 95
Among the challenges of facial plastic surgeries are congenital defects of the nasal lateral cartilages, which are extremely rare. In this study, a case of a congenital unilateral agenesis of lower lateral cartilage is presented, in addition to a review of literature of case reports and possible reconstructions. For the reconstruction of the right lower cartilage, a lower lateral replacement graft using septal cartilage was performed. The successful aesthetic and functional outcome in this nasal malformation was achieved through open rhinoseptoplasty with the use of septal cartilage as a graft. The knowledge gained from the literature review and possible graft types available for reconstruction will prepare the surgeon to reconstruct the defect whenever encountered. Cite this article as: Martins KFdS, Bittar RF, Prado VB, Garcia SRRA. Unilateral agenesis of lower lateral cartilage reconstructed with septal graft: case report and literature review. B-ENT. 2026;21(3):159-164.
Neoadjuvant chemotherapy (NAC) has become a cornerstone in breast cancer treatment, especially for locally advanced tumors and aggressive subtypes such as triple-negative and HER2-positive disease. NAC can reduce tumor size, increase breast-conserving surgery (BCS) eligibility, improve cosmetic outcomes, and allow early systemic control. However, concerns persist regarding whether BCS following NAC achieves oncologic outcomes comparable to those of BCS followed by adjuvant chemotherapy (AC). This study aimed to compare long-term survival outcomes in patients undergoing BCS after NAC versus AC in a real-world Brazilian cohort. We conducted a retrospective, multicenter cohort study across six Brazilian institutions (five private, one public). Women aged 18 years or older with clinical stage 0-III breast cancer who underwent BCS (either standard lumpectomy or therapeutic mammoplasty) between 2016 and 2022 were included. Patients were divided into two groups according to whether they received NAC or AC. Data on demographics, tumor characteristics, and treatments were collected from institutional registries. The outcomes assessed were locoregional recurrence-free survival (LRRFS), distant recurrence-free survival (DRFS), breast cancer-specific survival (BCSS), progression-free survival (PFS), and overall survival (OS). Survival outcomes were estimated using Kaplan-Meier methods, and Cox proportional hazards models were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs). This study was approved by the IDOR Ethics Committee (reference 6,907,736). A total of 268 women underwent breast-conserving surgery; 138 (51.5%) received NAC and 130 (48.5%) received AC. The mean age of the cohort was 53.1 years (SD 12.1), with patients in the NAC group being slightly younger (mean 51.1 vs. 55.2 years). Over half of the patients (56.8%) were over 50 years old, and 51.1% identified as white. Invasive ductal carcinoma was the predominant histological type (84.7%), and the majority of patients (73.8%) presented with early-stage disease (≤ stage IIA). Most underwent lumpectomy (72.4%), while 27.6% had therapeutic mammoplasty. In the NAC group, 57.2% had tumors classified as stage >IIB. After a median follow-up of 60 months, no statistically significant differences were observed in survival outcomes between the NAC and AC groups. The hazard ratio for LRRFS was 1.29 (95% CI: 0.28-5.88; p=0.816), for BCSS was 0.52 (95% CI: 0.10-2.61; p=0.473), for DRFS was 1.05 (95% CI: 0.31-3.52; p=0.955), for PFS was 1.19 (95% CI: 0.36-3.96; p=0.869), and for OS was 0.73 (95% CI: 0.18-2.91; p=0.710). In this multicenter Brazilian cohort, breast-conserving surgery following neoadjuvant chemotherapy was associated with survival outcomes comparable to those of surgery followed by adjuvant chemotherapy. These findings support the oncologic safety of BCS after NAC and reinforce its role as a safe and effective option in the individualized surgical management of breast cancer. A. Dominique Nascimento Lima, A. Mattar, F. Pimentel Cavalcante, F. Pereira Zerwes, M. Antonini, M. Leite Kraft, A. Oliveira de Alencar, A. de Queiroz Germano, D. Pitanga Torres, E. Goulart Carneiro, C. Freitas de Lima, R. Zocchio Torresan, F. Palermo Brenelli, M. Lichtenfels, A. Frasson, J. Bines, E. Camargo Millen. Is it safe to offer breast-conserving surgery after neoadjuvant chemotherapy? A Brazilian multicenter cohort study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-03-09.
Background:Anterior lumbar interbody fusion (ALIF) is widely employed in the treatment of degenerative lumbar disorders. However, ALIF may require manipulation or retraction of major vascular structures, thereby increasing the risk of transient ischemia. Intraoperative neurophysiological monitoring with somatosensory-evoked potentials (SSEPs), combined with digital oximetry (DO), may more effectively detect the onset of lower-extremity hypoperfusion or major vascular compromise during ALIF. Methods:Thirty consecutive patients underwent ALIF for lumbar spondylodiscoarthropathy. Intraoperative SSEP recording and digital pulse oximetry were performed; episodes of desaturation (SpO2 < 90%) and SSEP changes (amplitude reduction or latency increase) were documented. Associations between desaturation and SSEP alterations were analyzed using Fisher's exact test. Results:Peripheral desaturation and SSEP alteration each occurred in one patient (3.3%), with no significant association (P > 0.999). No vascular injuries were identified. Postoperatively, all patients experienced significant lumbar pain relief (median verbal numerical scale reduction from 8 to 2; P < 0.001), with sensory improvement in 69% and motor recovery in one of two cases with paresis. Conclusion:A causal link between DO desaturation and SSEP changes during ALIF appears unusual. Nevertheless, concurrent monitoring enhances intraoperative safety and is advisable in procedures involving vascular manipulation. The results support the safety and clinical efficacy of the anterior approach when performed by experienced teams in selected patients.
Introduction: Breast cancer is currently considered as a public health issue. To avoid late diagnosis, there is an attempt to use appropriate screening programs addressed to the early detection by testing the asymptomatic population in order to identify preclinical stage lesions. Methods: This is a retrospective, analytical, cross-sectional study of the notifications available in the cancer information system. The incidence of notifications from the reports of the BI-RADS™ notification system (Breast Imaging Reporting Data System) was compared between women at high and usual risk for breast cancer. Results: In the analyzed period, from 2013 to 2021, 16,065,383 screening mammographies were performed and notified in Brazil. Of these, 13,167,259 were performed in usual-risk women, whereas 2,898,124 were performed in high-risk women. To analyze the difference between reports of women at usual and high risk, the relative risk between them was calculated, as well as the necessary number to causa damage; the relative risk we found was of 0.5412 (95%CI 0.5341–0.5483) in B4 and relative risk of 0,433 (95%CI 0.4203–0.4462). As to the necessary number to cause damage, we observed 203 (95%CI 198–209) for B4 and 788 (95%CI 754–825) for B5. Despite the well-established need for breast cancer screening programs to reduce mortality, some aspects of screening do not have such a consensus. In this study, the incidence of reports that are suggestive of malignant breast lesions was higher among women at high risk. Conclusions: The study showed an increased prevalence of reports suggestive of malignancy in high-risk patients when compared to those at usual risk.
