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The growing demand for electricity in large Brazilian cities and the distance to the region with the largest energy production have encouraged the construction of transmission lines thousands of kilometers long, crossing several states of the federation. Therefore, the heterogeneity of requirements in federal, state and district environmental laws tend to lead to uncertainty for the investor regarding procedures and investments necessary for the completion of the project, as well as the time that the requirements will take to be fulfilled. In the present study, we identify and compare the criteria used by the various environmental licensing agencies for classifying transmission system projects in the different procedures (simplified and ordinary) of environmental licensing. It was possible to expose the differences and demonstrate some inconsistencies in the legislation of some Brazilian states. In particular, we note an absence of proportionality between the licensing requirements and the expected environmental impacts for projects on the physical, biological and social environments. Additionally, it was identified subjectivity in the requirement for social participation through public hearings, demanded by the legislation for the projects classified in the ordinary procedure.

Resumo Os aneurismas de artérias viscerais (AAVs) e pseudoaneurismas de artérias viscerais (PAAVs) são condições raras e potencialmente letais quando rotos. Em geral, são encontrados incidentalmente na tomografia computadorizada de pacientes assintomáticos. Embora a cirurgia aberta convencional seja considerada atualmente o tratamento padrão ouro, a abordagem endovascular vem ganhando relevo por ser considerada um procedimento minimamente invasivo e com riscos cirúrgicos menores. Destaca-se, nessa abordagem, o uso de embolização por molas (coils) em AAVs e PAAVs saculares e implante de stent modulador de fluxo como alternativa de tratamento para aneurismas fusiformes. Apresentamos o caso de uma paciente de 51 anos com queixa de dor abdominal aguda, taquicardia e hipotensão, com evidência de sangramento abdominal em angiotomografia e diagnóstico de pseudoaneurisma de artéria ileocólica (AIC) roto. Ela foi submetida a tratamento endovascular precoce de embolização da AIC com sucesso, e houve melhora do quadro clínico.

Nonalcoholic fatty liver disease (NAFLD) is a common chronic condition associated with genetic and environmental factors in which fat abnormally accumulates in the liver. NAFLD is epidemiologically associated with obesity, type 2 diabetes, and dyslipidemia. Environmental factors, such as physical inactivity and an unbalanced diet, interact with genetic factors, such as epigenetic mechanisms and polymorphisms for the genesis and development of the condition. Different genetic polymorphisms seem to be involved in this context, including variants in PNPLA3, TM6SF2, PEMT, and CHDH genes, playing a role in the disease’s susceptibility, development, and severity. From carbohydrate intake and weight loss to omega-3 supplementation and caloric restriction, different dietary and nutritional factors appear to be involved in controlling the onset and progression of NAFLD conditions influencing metabolism, gene, and protein expression. The polygenic risk score represents a sum of trait-associated alleles carried by an individual and seems to be associated with NAFLD outcomes depending on the dietary context. Understanding the exact extent to which lifestyle interventions and genetic predispositions can play a role in the prevention and management of NAFLD can be crucial for the establishment of a personalized and integrative approach to patients.

Abstract Background: Basal cell and squamous cell carcinomas (BCC and SCC) are the most common types of cancer worldwide. Intraoperative assessment of surgical margins by frozen section has been widely used to ensure disease-free margins. The intraoperative ‟en face” freezing technique evaluates all peripheral and deep margins. Objective: To report the results of the ‟en face” freezing technique in relation to tumor recurrence and agreement with paraffin-embedded tissue examination. Methods: Retrospective analysis of patients undergoing surgical excision of BCC and SCC at the A. C. Camargo Cancer Center, Brazil. Results: This study included 542 skin carcinomas, which were excised from 397 patients. A total of 201 male patients (50.6%), and 196 female patients (49.4%) were assessed, whose mean age was 64 years. The tumors were mostly located on the head and neck region (87.8%). BCC corresponded to 79.7% of the cases. The mean follow-up was 38 months. Tumor relapse occurred in 0.86% of the primary tumors and 3.7% of recurrent tumors. The result of the intraoperative ‟en face” frozen section evaluation was in agreement with the final result of the anatomopathological examination (paraffin test) in 98% of the lesions. Study limitations: Not having a minimum follow-up time of 5 years for all patients. Conclusion: The ‟en face” freezing technique shows low tumor relapse, being reliable and safe to guarantee negative surgical margins of the tumor.

Introduction: Tissue repair and skin wound healing are complex processes that involve a series of dynamic events, including coagulation, inflammation, granulation tissue formation, wound contraction and tissue remodeling. The need to care for patients with difficulties in wound healing is a growing challenge and requires innovative strategies. One approach that stands out in the treatment of these injuries is low-power laser therapy. This study aims to demonstrate the applicability and results of a low-power laser therapy protocol in the management of skin wound healing. Methods: This is a retrospective case review study reporting the use of laser in the treatment of skin wounds in a single center. Results: We evaluated the results of the implementation of this low-power laser therapy protocol and reported five cases of patients with skin wounds that did not improve with conventional treatment. The lesions were located in different places, with lesions on the trunk, upper limb and lower limb. The five cases showed a good response to laser therapy, evolving with wound healing in a short period of time, with an average healing time of 48 days. Conclusion: It is concluded that low power laser therapy when applied to skin wounds suggests a beneficial, promising action and has the potential to increase the therapeutic options available to the surgeon, however as we report a number of five cases, further studies are needed for check laser efficiency on wounds.

Introduction: Scalp reconstruction after cancer resection remains a challenge for surgeons, especially considering the increasing incidence of skin cancer among elderly patients. Dermal matrix (DM) is a heterogeneous group of wound covering materials that aid in wound closure and replace some of the skins functions, either temporarily or permanently. Patients at higher surgical risk can benefit from the use of DM, which help to generate a new dermis, offering great improvements in coverage of complex and extensive defects Methods: It is a retrospective study with analysis of medical records and report of two cases of patients at the A.C.Camargo Cancer Center-SP, Brazil. Results: We report two cases of complex and extensive scalp defects at a single center using DM associated with skin grafting and negative pressure therapy (NPT) in reconstructive surgery after resection of malignant skin neoplasm with satisfactory functional and esthetic results. Conclusions: Extensive lesions of the scalp are a challenge in clinical practice and a multidisciplinary treatment is essential. The results obtained indicate that DM associated with partial skin grafting and NPT have enormous potential to increase the therapeutic options available to the surgeon and possibly benefit patients, especially those who do not have the clinical conditions for extensive coverage surgery with microsurgical flap.