Brazilian Society of Surgical Oncology recommendations on Merkel cell carcinoma surgical treatment.

BACKGROUND: Merkel cell carcinoma (MCC) is a rare neuroendocrine skin cancer with poor 5-year survival rates. Surgery and radiation are the current first-line treatments for local and nodal disease. OBJECTIVES: The Brazilian Society of Surgical Oncology developed this document aiming to guide the surgical oncology role in multimodal MCC management. METHODS: The consensus was established in three rounds of online discussion, achieving consensus on specific topics including diagnosis, staging, treatment, and follow-up. RESULTS: Patients suspected of having MCC should undergo immunohistochemical examination and preferably undergo pathology review by a dermatopathologist. Initial staging should be performed with dermatologic and nodal physical examination, combined with complementary imaging. Whole-body imaging, preferably with positron emission tomography (PET) or computed tomography (CT) scans, are recommended. Due to the need for multidisciplinary approaches, we recommend that all cases should be discussed in tumor boards and referred to other specialties as soon as possible, reducing potential treatment delays. We recommend that all patients with clinical stage I or II may undergo local excision associated with sentinel lymph node biopsy. The decision on margin size should consider time to recovery, patient's comorbidities, and risk factors. Patients with positive sentinel lymph nodes or the presence of risk factors should undergo postoperative radiation therapy at the primary site. Exclusive radiation is a viable option for patients with low performance. Patients with positive sentinel lymph node biopsy should undergo nodal radiation therapy or lymphadenectomy. In patients with nodal clinical disease, in addition to primary tumor treatment, nodal radiation therapy and/or lymphadenectomy are recommended. Patients with advanced disease should preferably be enrolled in clinical trials and discussed in multidisciplinary meetings. The role of surgery and radiation therapy in the metastatic/advanced setting should be discussed individually and always in tumor boards. CONCLUSION: This document aims to standardize a protocol for initial assessment and treatment for Merkel cell carcinoma, optimizing oncologic outcomes in middle-income countries such as Brazil.

Replacing Plastics with Alternatives Is Worse for Greenhouse Gas Emissions in Most Cases.

Plastics are controversial due to their production from fossil fuels, emissions during production and disposal, potential toxicity, and leakage to the environment. In light of these concerns, calls to use less plastic products and move toward nonplastic alternatives are common. However, these calls often overlook the environmental impacts of alternative materials. This article examines the greenhouse gas (GHG) emission impact of plastic products versus their alternatives. We assess 16 applications where plastics are used across five key sectors: packaging, building and construction, automotive, textiles, and consumer durables. These sectors account for about 90% of the global plastic volume. Our results show that in 15 of the 16 applications a plastic product incurs fewer GHG emissions than their alternatives. In these applications, plastic products release 10% to 90% fewer emissions across the product life cycle. Furthermore, in some applications, such as food packaging, no suitable alternatives to plastics exist. These results demonstrate that care must be taken when formulating policies or interventions to reduce plastic use so that we do not inadvertently drive a shift to nonplastic alternatives with higher GHG emissions. For most plastic products, increasing the efficiency of plastic use, extending the lifetime, boosting recycling rates, and improving waste collection would be more effective for reducing emissions.

Development of bioenergy technologies: A scientometric analysis.

Bioenergy has the potential to substitute the current demand for fossil fuels in various applications. Recovering energy from bio-based materials due to environmental considerations has been adopted as a policy objective by governments and international organizations, which led to both vast financial investment and scientific research, especially in the last two decades. So far, various feedstocks and technologies have been scrutinised by the research community, although not all of them are commercially adopted due to sustainability considerations. This study employs scientometric analysis to survey the progress of scientific development in the field of bioenergy from 1966 to 2022, using ten parameters including publication year, type of document, categories, countries, affiliations, document citations, co-authorship, author citation networks, journal citation networks, and keywords. A total of 51,905 scientific documents were collected from the Web of Science, involving more than 96,000 authors from 162 countries. The dispersion of studies followed an ascending distribution with a sharp increase in the second half of the 2000s. The evolution of keywords in terms of burst strength confirmed the advancements of technologies from primary first-generation to advanced fourth-generation bioenergies. Based on the evolution of science in this area, it is concluded that integrated sustainability assessment studies, covering technical, economical, environmental, and social aspects, are needed to bridge the gap between abundant theoretical endeavours and limited commercial use of this energy source.

Evaluating the environmental profiles of winter wheat rotation systems under different management strategies.

Climate change poses a remarkable challenge to global food security, for which wheat is one of the main staple agricultural commodities. The cultivation of different varieties of winter wheat in Galicia (commercial and native) under rotation systems with potato, maize and oilseed rape was evaluated from an environmental point of view. The general approach of this study included the gathering of the inventory data of the different crops, the quantification of their environmental impacts and economic benefits, to identify the best land management system. Life Cycle Assessment (LCA) was used as environmental tool. The environmental profiles of each rotation system were reported in terms of nine impact categories. Crop rotations were analysed both per hectare and per € of gross margin, so that the information can be relevant to land-management decisions. Preference ranks were established based on an environmental normalized score for both units. The results suggest that arable operations contribute decisively to the environmental profile of the rotations. The avoided mineral fertilization processes, the carbon storage in the soil when returning straw to the field, as well as the electricity production clearly influence the environmental impact of the rotations. Scenarios that include native wheat under organic management are always the environmentally preferred ones while the preferred alternate crop depends on the reference unit. Concerning the margin gross, scenarios including the native variety report the highest profits, being the potato the preferred alternate crop. Further assessment needs to be undertaken to identify differences in the results of different ways of conducting LCA, i.e. attributional vs consequential approaches.

Environmental footprint family to address local to planetary sustainability and deliver on the SDGs.

The number of publications on environmental footprint indicators has been growing rapidly, but with limited efforts to integrate different footprints into a coherent framework. Such integration is important for comprehensive understanding of environmental issues, policy formulation and assessment of trade-offs between different environmental concerns. Here, we systematize published footprint studies and define a family of footprints that can be used for the assessment of environmental sustainability. We identify overlaps between different footprints and analyse how they relate to the nine planetary boundaries and visualize the crucial information they provide for local and planetary sustainability. In addition, we assess how the footprint family delivers on measuring progress towards Sustainable Development Goals (SDGs), considering its ability to quantify environmental pressures along the supply chain and relating them to the water-energy-food-ecosystem (WEFE) nexus and ecosystem services. We argue that the footprint family is a flexible framework where particular members can be included or excluded according to the context or area of concern. Our paper is based upon a recent workshop bringing together global leading experts on existing environmental footprint indicators.

Estimating 20-year land-use change and derived CO2 emissions associated with crops, pasture and forestry in Brazil and each of its 27 states.

Land-use change (LUC) in Brazil has important implications on global climate change, ecosystem services and biodiversity, and agricultural expansion plays a critical role in this process. Concerns over these issues have led to the need for estimating the magnitude and impacts associated with that, which are increasingly reported in the environmental assessment of products. Currently, there is an extensive debate on which methods are more appropriate for estimating LUC and related emissions and regionalized estimates are lacking for Brazil, which is a world leader in agricultural production (e.g. food, fibres and bioenergy). We developed a method for estimating scenarios of past 20-year LUC and derived CO2 emission rates associated with 64 crops, pasture and forestry in Brazil as whole and in each of its 27 states, based on time-series statistics and in accordance with most used carbon-footprinting standards. The scenarios adopted provide a range between minimum and maximum rates of CO2 emissions from LUC according to different possibilities of land-use transitions, which can have large impacts in the results. Specificities of Brazil, like multiple cropping and highly heterogeneous carbon stocks, are also addressed. The highest CO2 emission rates are observed in the Amazon biome states and crops with the highest rates are those that have undergone expansion in this region. Some states and crops showing large agricultural areas have low emissions associated, especially in southern and eastern Brazil. Native carbon stocks and time of agricultural expansion are the most decisive factors to the patterns of emissions. Some implications on LUC estimation methods and standards and on agri-environmental policies are discussed.

GUIDELINE FOR THE MANAGEMENT OF BILE DUCT CANCERS BY THE BRAZILIAN GASTROINTESTINAL TUMOR GROUP.

The Brazilian Gastrointestinal Tumor Group developed guidelines for the surgical and clinical management of patients with billiary cancers. The multidisciplinary panel was composed of experts in the field of radiology, medical oncology, surgical oncology, radiotherapy, endoscopy and pathology. The panel utilized the most recent literature to develop a series of evidence-based recommendations on different treatment and diagnostic strategies for cholangiocarcinomas and gallbladder cancers.

Guideline for the management of bile duct cancers by the brazilian gastrointestinal tumor group

ABSTRACT The Brazilian Gastrointestinal Tumor Group developed guidelines for the surgical and clinical management of patients with billiary cancers. The multidisciplinary panel was composed of experts in the field of radiology, medical oncology, surgical oncology, radiotherapy, endoscopy and pathology. The panel utilized the most recent literature to develop a series of evidence-based recommendations on different treatment and diagnostic strategies for cholangiocarcinomas and gallbladder cancers.

RESUMO O Grupo Brasileiro de Tumores Gastrointestinais desenvolveu diretrizes de tratamento cirúrgico e clínico de pacientes com tumores de vias biliares. O painel multidisciplinar foi composto de especialistas nas áreas radiologia, oncologia, cirurgia, radioterapia, endoscopia e anatomia patológica. O painel utilizou literatura atual para desenvolver recomendações baseadas em evidência científica para as diferentes estratégias terapêuticas e diagnósticas dos colangiocarcinomas e tumores de vesícula biliar.

Absence of Tumor-Infiltrating Lymphocyte Is a Reproducible Predictive Factor for Sentinel Lymph Node Metastasis: A Multicenter Database Study by the Brazilian Melanoma Group.

AIMS: The aim of this study is to confirm the function of tumor-infiltrating lymphocytes (TILs) in sentinel lymph node (SLN) metastasis. MATERIALS AND METHODS: This retrospective study included 633 patients with invasive melanoma who underwent sentinel lymph node biopsy in 7 referral centers certified by the Brazilian Melanoma Group. Independent risk factors of sentinel node metastasis (SNL) were identified by multiple logistic regression. RESULTS: SLN metastasis was detected in 101 of 633 cases (16.1%) and in 93 of 428 patients (21.7%) when melanomas ≤ 1mm were excluded. By multiple logistic regression, the absence of TILs was as an independent risk factor of SLN metastasis (OR = 1.8; 95%CI: 1.1-3.0), in addition to Breslow index (greater than 2.00 mm), lymph vascular invasion, and presence of mitosis. CONCLUSION: SLNB can identify patients who might benefit from immunotherapy, and the determination of predictors of SLNB positivity can help select the proper population for this type of therapy. The absence of TILs is a reproducible parameter that can predict SLNB positivity in melanoma patients, since this study was made with several centers with different dermatopathologists.

MAP Kinase Pathways: Molecular Roads to Primary Acral Lentiginous Melanoma.

The etiology and pathogenesis of lentiginous acral melanomas are poorly understood. Recent studies have postulated that DNA repair mechanisms and cell growth pathways are involved in the development of melanoma, particularly changes in the MAPK pathways (RAS, BRAF, MEK 1/2, and ERK 1/2). The aim of this study is to assess the status of the MAP kinase pathways in the pathogenesis of acral melanomas. The authors examined the components of the RAS-RAF-MEK-ERK cascades by immunohistochemistry in a series of 16 primary acral melanomas by tissue microarray. The expression of MAP kinase cascade proteins changed in most cases. The authors observed that 57.14% of cases were BRAF positive and that 61.53%, 71.42%, and 71.42% of cases were positive for MEK2, ERK1, and ERK2, respectively; RAS was not expressed in 92.31%, and all cases were negative for MEK1. The absence of RAS and positivity for MEK2, ERK1, and ERK2 were most seen in invasive cases with high thickness. These aspects of the MAPK pathway require further examination in acral melanomas between different populations. Nevertheless, the results highlight significant alterations in the MAP kinase cascades that are related to histological indicators of prognosis in primary acral melanomas.

Múltiplas metástases ósseas de carcinoma basocelular cutâneo / Multiple Bone Metastases from Basal Cell Carcinoma of the skin

Relato de uma paciente feminina com múltiplas metástaes ósseas de carcinoma basocelular cutâneo

Tumor de células granulares no pé (tumor de Abrikossof): localização infreqüente de tumor relativamente raro / Foot granular cell tumor (Abrikossof's tumor): unusual location of a relatively uncommon tumor

Descrevem-se os aspectos clinicopatológicos de um caso de tumor de células granulares em localização infreqüente

Carcinoma pilomatricial (pilomatricoma maligno): relato de um caso e revisão de literatura / Pilomatrix carcinoma (malignant pilomatricoma): a case report and review of the literature

Foram descritas as características clinicopatológicas de um caso de carcinoma pilomatricial e revistos os achados clínicos e patológicos desse raro tumor

Catéter venoso totalmente implantável em 278 pacientes oncológicos / Totally implantable venous catheter in 278 oncology patients

Os catéteres totalmente implantáveis proporcionam acesso vascular prolongado, baixo risco durante inserção e remoção, fácil manutenção, conforto e segurança para o paciente e baixo índice de complicações. Nosso objetivo é relatar a experiência com 278 catéteres implantados por um único cirurgião. Foram critérios para o implante: diagnóstico histopatológico, expectativa de vida maior que 3 meses, dificuldade de acesso venoso periférico e programa de quimioterapia. Entre março de 1990 e março 1998 foram implantados 278 catéters em 272 pacientes. Tempo de permanência: 382 dias (5 a 2897) totalizando 106.457 dias...