O monitor multiparâmetros é um equipamento médico-assistencial utilizado para monitoramento de parâmetros fisiológicos dos pacientes, como o eletrocardiograma (ECG), que é capaz de fornecer uma ampla gama de indicadores da saúde do coração. O objetivo deste trabalho foi desenvolver um firmware para o monitor multiparâmetros, desenvolvido por uma empresa nacional, detectar algumas anomalias no sinal de eletrocardiograma: taquicardia, bradicardia, arritmia, bloqueio e parada sinusal. Como resultados, destaca-se que o método utilizado para medição dos intervalos R-R do eletrocardiograma apresentou um erro absoluto máximo de 3,37% e uma taxa de acerto de 99,67% na detecção das anomalias.
BACKGROUND:The long-term impact of bariatric procedures on gastroesophageal reflux disease (GERD) remains insufficiently characterized. Sleeve gastrectomy (LSG) is technically simpler but may predispose patients to reflux, whereas Roux-en-Y gastric bypass (LRYGB) is recognized for its durable anti-reflux effect. Robust prospective data comparing the procedures beyond 5 years are scarce. This study compared 8-year persistent or new-onset GERD after LSG versus LRYGB using multimodal assessment based on Lyon Consensus 2.0 criteria. METHODS:In this prospective dual-cohort extension of a previous trial (n = 75), 51 patients (LSG = 19; LRYGB = 32) completed 8-year follow-up. Multimodal assessment included a symptom questionnaire, upper endoscopy, contrast radiology, manometry, and 24-h pH monitoring. The primary endpoint was conclusive GERD per Lyon 2.0 classification. RESULTS:Conclusive GERD was present in 94.7% of LSG patients compared with 25.0% following LRYGB (RR = 3.8; 95% CI, 2.06-6.97). Erosive esophagitis (Los Angeles grade ≥ B) was more frequent after LSG (73.7% vs. 18.8%; p < 0.001). Mean acid exposure time was higher after LSG (11.4 ± 6.0% vs. 2.7 ± 5.5%; p < 0.001). Pathological DeMeester scores (> 14.7) occurred in 66.7% of LSG patients versus 19.0% after LRYGB (RR = 3.44; p = 0.002). GERD-related complications, including Barrett's esophagus and conversion to LRYGB, were observed only after LSG. CONCLUSION:At 8-year follow-up, LSG is strongly associated with persistent or de novo GERD, whereas LRYGB maintains a durable protective effect. These findings highlight the relevance of appropriate preoperative evaluation and long-term reflux surveillance when selecting bariatric procedures. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT03692455.
The assessment of response to neoadjuvant systemic therapy (NST) is a critical pillar in defining the multidisciplinary therapeutic strategy in breast cancer. This consensus aimed to establish national guidelines for imaging assessment of NST, based on the best scientific evidence adapted to the Brazilian context. To this end, a panel of experts was formed, composed of breast radiologists, breast surgeons, oncologists, onco-radiotherapists and breast patholo-gists. The methodology was based on a systematic literature review, followed by face-to-face discussions and rounds of virtual voting (adapted Delphi method), defining consensus when agreement was =75%. As a result, radiological response criteria were standardized, and accuracy, false-negative, and positive rates were determined, as well as the role of mammography, ultrasound, magnetic resonance imaging, and tomosynthesis, stratified by molecular subtypes. Additionally, recommendations were established for marking the breast lesion and axillary lymph nodes before the start of treatment. Finally, the role of other imaging techniques, such as contrast-enhanced mammography and pos-itron-emission tomography/computed tomography, was discussed, as well as the impact of artificial intelligence as tools for evaluating the response to SNRT.
