Implications for practiceWe are unable to draw definitive conclusions about the comparative effects of cuffed or non-cuffed endotracheal tubes in children undergoing general anaesthesia. Our confidence is limited by risks of bias, imprecision and indirectness. The lower requirement for exchange of tubes with cuffed ETTs was very low-quality evidence, and the requirement for less medical gas used and consequent lower cost was low-quality evidence. In some cases, tracheal re-intubation is required to guarantee an open airway when adequate oxygenation is difficult after removal of the tube, for a variety of reasons including stridor, muscle weakness or obstruction. No data were available to permit evaluation of whether appropriate tidal volumes were delivered. Implications for researchLarge randomized controlled trials of high methodological quality should be conducted to help clarify the risks and benefits of cuffed ETTs for children. Such trials should investigate the capacity to deliver appropriate tidal volume. Future trials should also address cost effectiveness and respiratory complications. Such studies should correlate the age of the child with the duration of intubation, and with possible complications. Studies should also be conducted in newborn babies. Future research should be conducted to compare the effects of the different types or brands of cuffed tubes used worldwide. Finally, trials should be designed to perform more accurate assessments and to diagnose the complications encountered with cuffed compared to uncuffed ETTs.

The reconstructive and aesthetic breast surgery is a major breakthrough for the treatment of women fighting cancer. An advantage for the patient is the reduction of surgical treatment to one professional, besides the psychological and aesthetic relief of having her breast comfortably reconstructed by the doctor who is already accompanying her in the treatment of the disease. Considering the advances in oncological breast surgery, fhe ideal surgical procedure is one that achieves local control of the disease by maintaining the symmetry of the breast with immediate reconstruction. Plastic surgery techniques can be used in breast cancer surgery. The original focus is on improving the quality of life of oncological patients undergoing treatments that may be more effective in the aesthetic and functional point of view from the perspective of traditional techniques of breast conservation. Formation and training of professionals able to treat breast cancer is an innovative concept that brings discussions to the scientific community. Specific studies are required to standardize oncoplastic training. Training in reconstructive and aesthetic breast surgery also brings about new perspectives of surgical research related to aesthetic results, quality of life and local control, as well as the optimization of operative time, reducing adverse effects and costs. This study aimed to evaluate the main existing techniques, the training time for specialization in the context of Brazilian reality and whether it is necessary to change the current training model. This review is based on the conviction shown in other publishing studies (in press), which demonstrate the best way and the best work load for the improvement of the mastologist regarding oncoplastic and reconstructive breast surgeries.

Objectives: To compare propofol and midazolam in adult intensive care patients in relation to length of ICU stay, length of mechanical ventilation (MV) and time until extubation. Methods: MEDLINE, EMBASE, LILACS and Cochrane databases were searched from inception until July 2019 to retrieve RCTs that compared propofol and midazolam use as sedatives in adult ICU patients. There was no language restriction. We extracted and combined data from studies that reported to length of ICU stay, length of MV and time until extubation. A random-effects, meta-analytic model was applied in all calculations. Cochrane collaboration tool and GRADE were used to assess bias and certainty of the outcomes of the included studies, respectively. Two groups of patients were analyzed: elective surgical patients and critically ill patients. Results: Elective surgical patients receiving propofol reduced ICU stay by 5.07 hours (MD -5.07; 95% CI -8.68 to -1.45; p ,0.006, I 2 = 41 %, 5 studies), MV time by 4.28 hours (MD -4.28; 95% CI -4.62 to -3.94 (p ,0.00001, I 2 = 0, 3 studies), extubation time by 1.92 hours (MD -1.92; 95% CI -2.71 to -1.13; p ,0.00001, I 2 = 89%, 9 studies) compared to patients receiving midazolam. Critically ill patients receiving propofol reduced extubation time by 32.68 hours (MD -32.68; 95% CI -48.37 to -16.98; p ,0.0001, I 2 = 97%, 7 studies) compared to patients receiving midazolam. GRADE was very low for all outcomes. Conclusions: We conclude that propofol is a safe sedation strategy for general and elective surgery patients in the ICU. It is associated with improved outcomes when compared to the use of midazolam. Our data is in accordance with the recent sedation guideline (PADIS) recommendations where propofol can be used as the first-line sedative in adult ICU patients.

In 2020, the COVID-19 pandemic is the major healthcare concern around the world. The infection is especially severe to those with immune system suppression, including patients with cancer. In order to mitigate the negative effects of COVID-19, guidelines have been developed by societies worldwide to review oncology care during this pandemic time. Neoadjuvant endocrine therapy (NET) is a well-stablished option for hormone positive (HR) HER2 negative breast cancer and showed a positive response in breast conservative surgery with substantially less toxicity. Compared to chemotherapy, the NET cost is lower, and its administration is easier, due to less medical visits. Even with remarkable advantages, NET remains taking less place in treatments than it might have. Periods of humanity crisis, such as World Wars and other pandemics, boosted the development of science and established many treatments, which are currently practiced. New data generated during the COVID-19 outbreak can inspire more trials comparing chemotherapy to endocrine therapy within the neoadjuvant setting. The purpose of this letter is to suggest NET as a safe low toxicity treatment strategy for breast cancer, not only to postpone breast cancer surgery during the pandemic, but also to become a standard therapy, a flame kept burning crossing the COVID-19 border.

Introduction: Conserving surgery in the treatment of breast cancer, in association with radiotherapy, has replaced mastectomy in most cases. However, depending on the location and size of tumor, the classic conservative surgery can present unfavourable aesthetic results and high levels of commitment of the surgical margins. The oncoplastic breast surgery can have high local control rates and cause minimum breast deformities, leading to a better aesthetic result. Objective: To report cases of 30 patients with primary unilateral breast carcinoma who underwent oncoplastic surgery between 2013 and 2015. Methods: We used local and regional dermo-glandular rotation techniques. The average age of patients was 58.9 years. The average tumor size was 2.53 cm. Three patients had close or positive surgical margins and underwent a new surgical procedure. Results: The aesthetic result was evaluated by the BCCT.core program and was considered excellent in 11 cases, good in 12 cases and regular in 7 cases. Six patients had postoperative complications. Conclusion: The use of local and regional dermo-glandular rotation techniques allows extensive resections in breast conserving surgery, leading to a satisfying symmetry and a good aesthetic result without the need of symmetrization, with low postoperative complication rates and high rates of free surgical margins.KEYWORDS: Breast cancer; breast reconstruction; surgical flaps; surgical margins; cosmetic techniques. ABSTRACT RESUMOIntrodução: A cirurgia conservadora no tratamento do câncer de mama, associada à radioterapia, tem substituído a mastectomia na maioria dos casos. Entretanto, dependendo da localização e do tamanho do tumor, a cirurgia conservadora clássica pode resultar em um resultado estético insatisfatório e em altos índices de comprometimento de margens cirúrgicas. A cirurgia oncoplástica da mama pode apresentar altas taxas de controle local, causando deformidades mamárias mínimas, levando a um melhor resultado estético. Objetivo: Relatar casos de 30 pacientes com carcinoma mamário unilateral que foram submetidas à cirurgia oncoplástica da mama entre 2013 e 2015. Métodos: Foram utilizadas técnicas de rotação dermoglandular local e regional. A idade média das pacientes foi de 58,9 anos. O tamanho médio do tumor foi 2,53 cm. Três pacientes apresentaram margens cirúrgicas exíguas ou comprometidas, sendo submetidas a novo procedimento cirúrgico. Resultados: O resultado estético foi avaliado pelo programa BCCT.core, sendo considerado excelente em 11 casos, bom em 12 casos e regular em 7 casos. Seis pacientes apresentaram complicações pós-operatórias. Conclusão: A utilização de técnicas de rotação dermoglandular local e regional permite ressecções extensas na cirurgia conservadora da mama, permitindo uma simetria satisfatória e um bom resultado estético sem a necessidade de simetrização, com baixos índices de complicação pós-operatória e altas taxas de margens cirúrgicas livres.